Nursing Homes Take on Basic Medical Care

Long-term nursing homes may offer different levels of medical care, including specialty units for patients who suffer from chronic conditions.

When Cori Woods Solan of Pasadena, Calif., admitted her father, who had been diagnosed with Alzheimer’s disease seven years earlier, to an assisted living facility, the elderly man became increasingly irritable, angry, and aggressive.

“We were constantly worried about his behavior,” said Solan, who was busy with a new baby at the time. Living with Solan was soon not an option for her and her family. “He refused to shower and would then get into the fridge and touch all the food. He was frequently off balance and often tripped and fell.”

Her father soon landed in the hospital, following a transient ischemic attack (TIA). Being hospitalized only added to his confusion. “He didn’t understand why he was there; he didn’t even know he had a TIA,” Solan recalled.

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While there’s still a perception that hospitals are a safe zone, for many patients even necessary hospitalizations leave them in worse shape than they were before admission.  Decades of research have documented the risks of hospitalization for older adults.

According to a report in The New York Times, hospitalization of elderly patients often results in falls, hospital-acquired infections, delirium (from unfamiliar surroundings and medication interactions), and worsening memory for those with cognitive complaints.

But with government and health insurance plans pushing for a reduction in unnecessary hospitalizations, experts say the tide may be changing. Today, many seniors can get adequate care in nursing homes.

The halfway zone

A growing number of nursing homes offer 24/7 medical care in addition to changing, cleaning, feeding, and administering drugs to patients. Sometimes called progressive homes, such long-term facilities offer different levels of care, including specialty units for patients who are on ventilators or who suffer from chronic conditions, such as heart failure, dementia, and obesity.

“When patients don’t require the intensity of a full-service hospital, they’re diverted to nursing homes,” notes geriatrician Robert Stall, MD. “Many have sub-acute care units that act as step-down units from hospitals that were built with input from medical specialists.”

What would typically be a five- or six-day stay in a hospital may become one or two days in convalescent care.

Take Solan’s father, for example, who was diverted to a convalescent home after his TIA. “Medicare paid for his stay, but, when his two-week recovery period was up, they were very serious about the daily cost of having him stay longer,” Solan noted.

That’s a huge model shift from the traditional nursing home, characterized as a long-term care facility where people go to die. But it also leaves the patient or patient’s family with ongoing large medical fees.

Demanding a new level of care

An advantage to well-run nursing homes is that they tend to be more family friendly than hospitals. Good nursing homes even encourage family members to participate in the patient’s care. “The homes get free labor and the family members want to help,” says Stall.

The Medicare-Medicaid Coordination Office, in collaboration with the Centers for Medicare & Medicaid Innovation, launched the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents in 2012. The initiative supported organizations that partner with long-term care facilities to implement evidence-based interventions that improve care, lower costs, and reduce hospital readmissions. The initiative, which ended in 2020, found about half of costly hospital admissions for elders could be avoided, saving Medicare billions.

Unfortunately, many certified nursing homes remain ill-equipped to address common medical problems, manage IVs, and communicate with doctors about changes in residents’ health status.

So, it’s important to check out nursing homes thoroughly to understand what medical care they provide — and don’t provide — before making the best choice for an elderly person with health concerns.

If you’re investigating a new long-term residence for your loved one, ask these five questions:

1. How long has the home been taking patients as hospital diversions?
2. How big is their diversion program?
3. Who is the doctor in charge?
4. Is there a program in place to avoid unnecessary hospitalizations?
5. What is the protocol for residents who require care beyond what the home can provide?

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