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A national study has shown that being hospitalized for a stroke or hip fracture can lead to long-term institutionalization in a nursing home. Direct discharge to a skilled nursing facility put patients at "extremely high risk" of needing long-term nursing home care.
Researchers at the University of Texas Medical Branch in Galveston suggest that programs aimed at helping older patients recuperate successfully at home instead of in an institutional setting could greatly improve their health outcomes and reduce healthcare costs.
Lead author James S. Goodwin, MD, Director, Sealy Center on Aging at UTMB noted that certain factors common among the elderly -- cognition problems, frailty, lack of social support -- increase the risk of nursing home institutionalization.
Goodwin 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. Of that population, 75 percent were admitted to a nursing home for long-term care within six months of a hospital stay.
This correlated to Medicare's adoption of a prospective payment system that encouraged hospitals to reduce the length of stays.
Researchers also found several 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.
Goodwin recommends that hospitals consider alternatives to skilled nursing facilities post-hospitalization, such as community-based facilities, assisted living facilities and at-home care.
And that is a lesson for us. Understand what the discharge options are for your hospital and consider a hospital that offers options for rehabilitating at home.