Increased hospitalization risk tied to home- and community-based care: study

Seniors transferring from nursing homes to home- and community-based services (HCBS) are at 40 percent greater risk of “potentially preventable” hospitalizations, according to a new study of such transitions in seven states.

The results were published online by the Journal of the American Geriatrics Society just days before the Centers for Medicare & Medicaid Services (CMS) issued new regulations in an effort to ensure Medicaid financial support for seniors and individuals with disabilities receiving HCBS.

“We are trying to move people into the community, and I think that is a really great goal, but we aren’t necessarily providing the medical support services that are needed in the community,” says Andrea Wysocki, a postdoctoral scholar in the Brown University School of Public Health and lead author of the research. “One of the policy issues is, how do we care for not only the long-term care needs when we move someone into [HCBS], but also how do we support their medical needs as well?”

Wysocki performed the analysis for her doctoral thesis work at the University of Minnesota. She and her co-authors, from that institution and the University of Hong Kong, looked at a set of CMS-provided records of thousands of dually eligible seniors from Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont and Washington who entered nursing homes between 2003 and 2005.

Care provided in home and community settings during the study period may not have been as effective in preventing hospitalizations for two reasons, Wysocki says:

1. Nursing homes provide round-the-clock care by trained nurses and doctors, but workers with much less medical training provide HCBS.
2. In addition, although Medicaid pays for long-term care, Medicare pays for medical care, meaning that Medicaid programs do not have a built-in financial incentive to prevent hospitalizations. Home- and community-based care is less expensive for Medicaid regardless of the medical outcome.

Individuals who have long-term care, medical providers and a care plan at the time of transition could experience a lower risk of hospitalization and better long-term outcomes, the investigators note, adding that more can be learned from demonstration projects in which Medicare and Medicaid programs work together rather than separately. A more vigilant and effective treatment for chronic ailments that already are diagnosed (such as chronic obstructive pulmonary disease) also could prevent some of the hospitalizations that occur, Wysocki says.

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