Researchers urge hospitals to consider alternatives to SNFs during discharge

Discharge from the hospital to a skilled nursing facility after an acute event puts older patients at “extremely high risk” of needing long-term nursing home care, according to researchers at the University of Texas Medical Branch (UTMB).

James S. Goodwin, MD, director, Sealy Center on Aging at UTMB, and his colleagues measured a five percent sample of Medicare enrollees (approximately 762,000) aged 66 or older between 1996 and 2008 who were admitted to nursing homes. The percent of hospitalized Medicare patients transferred on discharge increased from 10.8 percent in 1996 to 16.5 percent in 2008.

Additionally, the study found that nearly 65 percent of patients in a nursing home six months after hospitalization had first been transferred to a skilled nursing facility upon discharge. The study was published online in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences.

Goodwin recommended that hospitals consider alternatives to SNFs post-hospitalization, such as community-based facilities, assisted living facilities and at-home care because “people fervently wish to remain at home and it is our responsibility to help avoid preventable nursing home admissions,” he said.

The researchers suggested that programs aimed at helping older patients recuperate successfully at home instead of in a long-term institutional setting could greatly improve their health outcomes and reduce healthcare costs.

Goodwin also suggested exploring ways to reduce the economic incentives of keeping patients in long-term care and divert savings to such alternatives and prevention programs.

“There is a very narrowly defined view of what Medicare will provide post-hospital,” said Goodwin. “If Medicare payment guidelines were broadened to cover in-home care—bathing and food preparation for example—there is a tremendous potential for savings and patients could adjust gradually back to their familiar home environment.”

According to Goodwin, the period studied paralleled a time of growth in the use of skilled nursing facilities, which may have been due to Medicare’s adoption of a prospective payment system that encouraged hospitals to reduce the length of stays.

Researchers also highlighted factors that reduced the risk of long-term institutionalization. Patients cared for in larger hospitals and major teaching hospitals were less likely to be in a nursing home six months after discharge, as were patients treated by their primary care physicians. In general, rates of nursing home institutionalization were lower in Midwest and Western states.

The study was funded by the National Institutes of Health.

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