How to Prevent Re-Hospitalization Of Nursing Home Residents: More Physicians and Nurses In Nursing Homes

Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care they need in the SNFs. 

A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 finds that residents who were not seen by a physician or advanced practitioner (10.4% of the total) had a higher likelihood of a poor outcome – return to the hospital, death, or failure to return successfully to the community.[3] Ensuring that physicians or other advanced practitioners see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations.

For many decades, inadequate nurse staffing levels have been correlated with re-hospitalizations of residents.[4] A three-year study of non-clinical factors that contributed to the re-hospitalization of residents, published thirty years ago,[5] found “insufficient and inadequately trained nursing staff” who could not meet residents’ complex health care needs as a cause of residents’ re-hospitalizations. A paper by Kaiser Family Foundation and Lake Research Partners in 2010[6] confirmed earlier findings about the multiple causes of re-hospitalizations and the need to increase nurse staffing levels in nursing facilities.
It is time to address the actual causes of re-hospitalizations of nursing home residents by providing better health care in SNFs. 

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[1] Affordable Care Act, §3025, 42 U.S.C. §1395ww(q), created the Hospital Readmissions Reduction Program.
[2] Protecting Access to Medicare Act (2014), §215, 42 U.S.C. §1395yy(h), created a Value-Based Purchasing Program for SNFs.  Beginning in fiscal year 2019 (services furnished on or after Oct. 1, 2018), the Centers for Medicare & Medicaid Services reduces Medicare payments to SNFs that have high rates of re-hospitalizations of their residents.
[3] Kira L. Ryskina, et al, “Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities,” Health Affairs 38, No. 4 (2019): 528-536, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05458 (abstract).  
[4] Center for Medicare Advocacy, “More Nurses in Nursing Homes Would Mean Fewer Patients Headed to Hospitals” (CMA Alert, Mar. 10, 2011), https://www.medicareadvocacy.org/more-nurses-in-nursing-homes-will-mean-fewer-patients-headed-to-hospitals/.
[5] J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989).
[6] Michael Perry, Julia Cummings (Lake Research Partners), Gretchen Jacobson Tricia Neuman, Juliette Cubanski (Kaiser Family Foundation), “To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care facility Residents; A Report Based on Interviews in Four Cities with Physicians, Nurses, Social Workers, and Family Members of Residents of Long-Term Care Facilities (Oct. 2010), https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8110.pdf.