There are 1.6 million Americans who reside in nursing homes. Each year, approximately 60 percent of nursing home residents will visit the emergency room and a quarter of them are admitted to the hospital annually. Nursing home residents are typically older and therefore may suffer from more numerous and serious ailments than the average population. But experts argue that this is not the sole reason for the large number of hospital visits and stays. According to LuMarie Polivka-West, senior vice president of the Florida Health Care Association, nursing homes may send their residents to the hospital when it is unnecessary or futile. It can occur due to pressure from the residents’ families who believe their loved ones will receive better care in a hospital. It can also happen when facilities fear they will be blamed if a nursing home resident dies. Long-term care experts argue that 28 to 40 percent of nursing home residents’ hospital stays could be avoided as they occur for the wrong reasons.
The Sun-Sentinel reports researchers at Florida Atlantic University are working to find ways to reduce the number of unnecessary hospital visits for nursing home residents. They are developing a program called Implementing Interventions to Reduce Hospitalizations of Nursing Home Residents or INTERACT. The program seeks to better train nursing home staff to identify health issues, track and document patient changes, and determine when it is prudent to send a patient to the hospital and when it is not.
Dr. Joseph G. Ouslander, senior associate dean at FAU’s Charles E. Schmidt College of Medicine, says that while hospitalization can be necessary, it is not always the right choice. Under the INTERACT program, if a patient fell while in a nursing home and needed treatment for a broken bone, the patient would be sent to the emergency room. Likewise, if a patient developed a bed sore in a nursing home, he or she would be hospitalized for treatment. But Ouslander argues that some hospitalizations are more harmful than helpful. It can be very stressful for the patient when nursing home resident is hospitalized and faces a battery of tests and therapies that may be painful without improving quality of life.
The INTERACT program raises questions about nursing home abuse. In some cases, such abuse is uncovered when a resident is transferred to a hospital for treatment. Unexplained bruises and other nursing home abuse indicators may be uncovered. Furthermore, it is unclear how a facility would handle a situation if a resident or his family desires hospital treatment but the INTERACT tools advise against it. The Affordable Care Act requires nursing homes implement quality assurance programs and Medicare will soon reduce payments for hospital re-admissions. Advocacy groups have recognized that these new policies and the INTERACT program may lead to nursing homes failing to send residents to the hospital when it is necessary.