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End-Stage Alzheimer's Patients Often Hospitalized Unnecessarily
Date:9/29/2011

entage of patients experiencing at least one burdensome transition was just 2 percent, while in Louisiana it was 37.5 percent, the investigators found.

What's more, areas with higher rates of burdensome transitions also had higher rates of poorer outcomes.

"People who live in a region with the highest rates of burdensome transitions have almost a twofold increase in the number of stage IV decubitus ulcers -- that's a bedsore with bone exposed. They're also twice as likely to stay in the ICU [intensive care unit], and they are threefold more likely to have a feeding tube inserted," noted Teno.

"What's really distressing is that when you take someone with a severe level of cognitive impairment out of their usual routine, they just don't do well. I can achieve better outcomes if I can treat them in the nursing home," she said.

But, the current way that Medicare and Medicaid pay nursing homes and hospitals encourages these types of transitions by offering additional incentives for patients who've been hospitalized, according to the study.

"There are substantial risks of hospitalization. Families need to know that there are risks to hospitalizations as well as benefits. But, not all hospitalizations are unnecessary or preventable. Trying to prevent every hospitalization would not be appropriate and would have negative consequences on overall care quality," said Dr. Joseph Ouslander, a professor and senior associate dean for geriatric programs at the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton.

However, he added that, "there are clearly some situations where patients don't need to be sent to the hospital, and care can be improved at a reduced cost in morbidity and discomfort as well as actual costs. The way things are being done is not the best care."

In addition to the current way hospitals and nursing homes are paid by Medicare and Medicaid, Ouslander said that concerns about legal l
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