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 Study: Rehospitalizations Nearly Twice As High When Elders Are Transferred To HCBS From Skilled Nursing

​The poorest elderly were nearly twice as likely to be sent back to the hospital with preventable conditions when they transferred from skilled nursing centers to home- or community-based care, a new study by Brown University researchers has concluded.

Using government data, researchers pored over the records of thousands of elderly poor who were in nursing homes between 2003 and 2005. Half of the sample had transferred into home- or community-based services (HCBS) and the other half remained in their skilled nursing centers.

Those seniors who went into HCBS from nursing homes were nearly 40 percent more likely to be sent back into the hospital with preventable conditions, the Brown University report says in this month’s edition of the Journal of the American Geriatrics Society.

Indeed, moving to HCBS increased the overall risk of hospitalization by 58 percent compared with those who stayed behind, lead researcher Andrea Wysocki writes for her colleagues.

“We are trying to move people into the community, and I think that is a really great goal,” Wysocki tells Brown University’s news site in announcing her findings, “but we aren’t necessarily providing the medical support services that are needed in the community. One of the policy issues is how do we care for not only the long term care needs when we move someone into home- and community-based settings but also how do we support their medical needs as well?”

Those who stayed in the skilled nursing centers were most likely to be hospitalized (extraneously or not) with kidney or lung diseases, Wysocki and her colleagues say. For those transferring into HCBS, lung disease was also a predictor of hospitalization.

“This suggests,” Wysocki writes in the study, “that there are few differences between the groups in the predictors of preventable hospitalizations, and the significant predictors seem to relate to diagnoses.”

Among other things, Wysocki and her colleagues say they hope policymakers and caregivers will think more broadly when moving residents from 24-hour nursing centers to HCBS.

“In addition to examining a more comprehensive set of outcomes for transitioners, transition programs should focus on ways to improve and ease individuals’ transitions over time and not just at the time of the move,” Wysocki writes.

For many long term care advocates, though, Wysocki and her colleagues are pushing on an open door.

“This study confirms what we already knew—that skilled nursing centers are the solution to addressing hospital readmissions for the elderly,” says Paul Liistro, an at-large board member of the American Health Care Association. “Assessment is key to preventing readmissions, and skilled nursing has the qualified, clinical professions readily available. What’s more, we are focused on this issue. Skilled nursing has shown measurable improvement, and we offer real, policy proposals that encourage nursing centers to continue to improve in this area.”

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