A primary cause of hospitalizations from nursing homes, discussed in industry literature for more than 20 years, is the inadequate health professional employment levels in nursing homes. Last fall, the Kaiser Family Foundation released two studies about the hospital stay of elderly care facility citizens. Their findings about why elderly care facility citizens are hospitalized confirm earlier research in this field and point to the need to increase health professional employment in nursing homes as a way to improve quality of care in assisted living features and reduce hospital stay and re-hospitalization of patients.
The Kaiser study, “Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information” determined the economical incentives that encourage hospital stay of elderly care facility citizens. These incentives include Medicare payment policies for doctors, skilled assisted living features, and hospice services as well as the dual roles of healthcare director and attending physician frequently being held by the same individual.
A companion study, based on interviews with doctors, nurses, social workers, and close relatives of residents, determined 10 factors that encourage hospital stay of elderly care facility residents: the limited capacity of assisted living features to address healthcare issues; physicians’ preference for inpatient settings; concerns with liability for not hospitalizing; economical incentives for doctors and facilities; inability of assisted living features to address residents’ healthcare needs; lack of relationship between facility staff, doctor, and family; lack of advance care planning; family preference; and behavioral health problems. Although several factors impact a decision to hospitalize an elderly care facility resident, a key factor determined in the Kaiser reviews and other studies mentioned is the lack of sufficient professional and paraprofessional medical staff in nursing homes. The insufficient employment in assisted living features has been recognized for a long period.