A recent study in The American Geriatrics Society, “Hospitalizations of Elderly Medicaid Long-Term Care Users Who Transition from Nursing Homes,” examines the rates of hospitalizations for people with extended nursing home stays who were transitioned to receive Home and Community Based Services (HCBS) versus those who remained in nursing homes. There has been a strong push recently by CMS to keep older adults from moving into nursing homes by providing them with HCBS, and several recent studies have focused on the likelihood of being readmitted to a nursing home after transitioning back into the community. This study, however, looks at the continuity of care that is provided to these individuals who are transitioned to HCBS.
The level of care that is provided in nursing homes differs significantly from the care that is provided to individuals who are living at home receiving home and community based services. Standard requirements at nursing homes, such as keeping care plans current, involving physicians in the care plan and completing regular assessments are not required with HCBS. The authors note, “Nursing professionals are trained to provide medical care and assistance with activities of daily living (ADLs), and NHs are required to perform periodic standard assessments, in collaboration with a physician, that are intended to be used to update care plans.” The staff of HCBS, the majority of whom are direct-care workers, usually do not have medical training. The level of care changes when residents leave the nursing home and they encounter a new set of providers when they reenter the community, which may prevent the continuity of the same level of care that they had from occurring.
The study found that the “transitioners” had a higher risk of potentially preventable hospitalizations as well as a higher risk of nonpreventable hospitalizations. This could be in part prevented by giving HCBS users a consistent set of providers so that there is familiarization with their medical problems in case a problem occurs. The authors note that policymakers should be aware of the potential for adverse outcomes when individuals are transitioned to HCBS, and should ensure that their medical needs are incorporated in transition planning.
View the study in the January 2014 volume of The American Geriatrics Society.