Residents suffering from advanced dementia are among the most vulnerable patients in nursing homes. These elderly patients are often bed-bound, unable to speak more than a few words, and prone to confusion or fear. Although it is less traumatic for dementia patients to remain in the nursing home, a recent New York Times blog points out that they are often subject to aggressive treatments and hospital transfers with limited clinical benefits.
A group of researchers at the Hebrew Senior Life Institute found that 75 percent of these hospitalizations may be avoidable, because dementia patients can be treated with equal effectiveness in the nursing home. Intravenous antibiotics can usually be administered there, along with palliative care that reduces fevers and helps patients breathe.
Not only is hospitalization extremely burdensome for patients, it's also costly. Over an 18-month period, researchers analyzed Medicare spending for more than 300 advanced dementia patients in Boston-area nursing homes. Hospital stays accounted for most of the spending, along with hospice care.
Cost-shifting may be part of the motivation. Dementia patients are often rushed to the hospital for common and recurring problems such as respiratory infections. Each time they return, they are covered for up to 100 days by Medicare, at higher rates than Medicaid payments may have covered them before.