Future of Long Term Care

The New York Times had an interesting article about the emergence of nursing homes replacing hospitals in providing basic medical care.  Certain procedures and treatments require hospital admission, of course. But “the push is to reduce unnecessary hospitalization for things that can be handled in skilled nursing facilities,” said David Siskind, the medical director at the Gurwin Jewish Nursing and Rehabilitation Center in Commack, N.Y.

Changing Medicare and Medicaid policies and incentives, and new HMO-like accountable care organizations, are encouraging these practices. But there would be greater optimism if nursing homes were adopting them faster.  20-plus years of research have documented the risks of hospitalization for older adults, particularly those frail or ill enough to need nursing home care.

A major obstacle to offering more procedures is a fact that often shocks families: Many of the nation’s 16,000 or so Medicare-certified nursing homes don’t employ round-the-clock registered nurses. Federal regulations require them only eight hours a day. Five states — Rhode Island, Connecticut, Hawaii, Maryland and Tennessee — mandate 24/7 nursing coverage; in several other states, staffing requirements are tied to facility size.

Digging through data compiled by the federal Agency for Healthcare Research and Quality, Medicare patients spent an average of 5.3 days in a hospital for blood transfusions in 2012. The mean cost: $10,339.  Savings like that will interest federal agencies seeking to control health care costs, but older adults also benefit. Families often regard the hospital as a protective haven, a place where lives are saved — not where infections develop or muscles atrophy. “We have to educate people,” Dr. Siskind said.