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Medicare patients at risk of long-term institutionalization after hospital stay
Date:10/3/2011

djust gradually back to their familiar home environment. Medicare will not pay for the in-home care."

Goodwin and his colleagues measured a five percent sample of Medicare enrollees (approximately 762,000) aged 66 or older between 1996 and 2008 who were admitted to nursing homes. Of that population, 75 percent were admitted to a nursing home for long-term care within six months of a hospital stay.

According to Goodwin, the period studied paralleled a time of growth in the use of skilled nursing facilities, which may have been due to Medicare's adoption of a prospective payment system that encouraged hospitals to reduce the length of stays.

Institutionalization after hospitalization increased with older age, in women and in patients without a primary care physician. The odds of institutionalization were also more than six-fold higher in patients with a dementia diagnosis and increased in patients with other co-morbidities, including delirium and incontinence.

Being transferred to a skilled nursing facility on discharge was the primary risk factor leading to substantial long-term care. The percent of hospitalized Medicare patients transferred on discharge increased from 10.8 percent in 1996 to 16.5 percent in 2008. Additionally, the study found that nearly 65 percent of patients in a nursing home six month after hospitalization had first been transferred to a skilled nursing facility. This was up from 50 percent in 1996.

Risk-reducing factors

Researchers also found several factors that reduced the risk of long-term institutionalization. Patients cared for in larger hospitals and major teaching hospitals were less likely to be in a nursing home six months after discharge, as were patients treated by their primary care physicians. In general, rates of nursing home institutionalization were lower in Midwest and Western states, where regulations, cultural and social factors may reduce nursing home use.

Goodwin recommends that
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Contact: Brianne ODonnell
brianne.odonnell@gabbe.com
212-220-4444
The Gerontological Society of America
Source:Eurekalert

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