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Are nursing homes sending too many patients to the hospital?

As many Chicago area families know, nursing home care should be a careful balance of comfort and medical treatment. For our loved ones who need 24-hour care and help with their basic needs, being a nursing home is about more than just having someone available in case of an emergency. It is also about achieving a level of comfort and ease for the resident.

However, in many cases residents do not receive the best possible care, as we have discussed many times on this blog in the past. One reason why care can suffer is because of tight budgets at nursing homes, which are often predominantly paid through Medicaid reimbursements. Experts say that changing Medicaid payment policies could have a big impact on care, particularly when it comes to the hospitalization rate of nursing home residents.

In a recent study published in the JAMA Internal Medicine journal, researchers found that while painful procedures are more common and costs increase when nursing home patients are hospitalized, there is no discernible improvement in their healthcare outcomes. Or, to put it more simply, when a patient is transferred from a nursing home to a hospital (in this study for dementia treatment) they undergo significantly more care that is not focused on comfort, but their health does not improve and they do not live longer.

So why are nursing homes transferring patients to hospitals if it doesn’t help? The answer is in the reimbursement plans for Medicaid and Medicare. Nursing homes typically receive reimbursements for specific services like a daily room and nursing care that do not increase when a patient needs treatment for an acute illness. As a result, they transfer patients to hospitals to avoid incurring the costs of the acute illness and the hospitals are reimbursed for the treatment by Medicare.

For families who are concerned about this process and want to make sure that their loved one is getting the best care and not suffering from negligent treatment in a nursing home, experts suggest pursuing managed care coverage insurance.

Source: Science Daily, “Managed Care Reduces Hospitalizations in Nursing Home Residents With Advanced Dementia,” Sept. 23, 2013. Tweet