A 2014 study published by The Journal of the American Geriatrics Society, “Restarting the Cycle: Incidence and Predictors of First Acute Care After Nursing Home Discharge” provides another look at one of the most popular healthcare trends – rehospitalizations. This study specifically looks at the length of time between a Medicare beneficiary’s discharge from a skilled nursing facility until that individual ended up making a visit to a hospital emergency room. The authors also tried to provide some indicators that increased the likelihood of a rehospitalization within the study’s sample (55,980 beneficiaries).
This deeper look at what happens to beneficiaries after they leave the hospital to go to a variety of settings has been the topic of much research. The Office of the Inspector General (OIG), in its “Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Requirements” report found that for 31% of nursing home residents in its sample, discharge requirements were not met. It further found that 23% of residents did not have post-discharge plans of care in place, including some instances where only verbal instructions were provided. With this information in mind, and the knowledge that care planning is a common “gotcha” area for nursing homes to get survey deficiencies in, the results of this study are not that surprising. Overall, the study found that:
- 22.1% of the sample had an acute care episode within 30 days of being discharged from a SNF
- 14.7% of this subsection were rehospitalized
- 37%% of the sample had an acute care use within 90 days of being discharged from a SNF
- 25.9% of this group were rehospitalized
As part of its 2013 Work Plan, the OIG also released a report, “Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring,” which reviewed the rate of nursing home residents that were transferred to hospitals in FY 2011. It found that hospitalization rates varied based on multiple factors, as this study does, including the availability and training of nursing staff at the facility.
However, it’s not just the care at nursing homes that creates rehospitalizations. Many states are quickly transitioning beneficiaries into managed care options, yet all the kinks in Home and Community Based Services (HCBS) have yet to be ironed out. In January, the Centers for Medicare & Medicaid Services (CMS) set out a rule to establish HCBS in Medicaid that will go into effect on March 17, 2014 and is meant to ensure that HBCS are available for aging adults. Studies have shown both the benefits of keeping aging adults in the community, as well as the drawbacks to these types of programs. For instance, a recent American Geriatrics Society study showed that older Medicaid LTC users were transitioned from nursing homes to HCBS were more likely to be hospitalized.