patients, nursing, trauma, elderly, home, homes, stroke, patient, discharge, care
A recent study found that elderly patients admitted to hospital trauma units are increasingly likely to be discharged to nursing homes instead of inpatient rehab facilities or home.The study, published in The Journal of Trauma and Acute Care Surgery, used data from 2003 to 2009. Researchers found that elderly trauma patients were about 34% more likely to be sent to a nursing home and 36% less likely to be sent to an impatient rehab facility (IRF) compared to other trauma patients.
To compare, stroke trauma patients were 78% more likely to be discharged to an IRF. Both stroke and elderly trauma patients are equally dependent on post-discharge rehabilitation. Being discharged to nursing homes is associated with higher risk of death for patients of any age.
The elderly are the fastest-growing trauma population, likely due to the rapid rise in Americans aged 65 and older. Researchers in this study note that hospitals should be investing their time and money to figure out how to ensure the best possible outcomes for elderly trauma patients. This can include investing in post-acute care discharge planning, according to the lead author of the study, Dr. Patricia Ayoung-Chee.
Dr. Chee mentioned that this type of discharge planning may have to be individualized to each patient. Currently, hospitals and trauma centers base much of their discharge decisions off reimbursement and insurance factors. Although this may be best financially, it is not often what is best for the patient.
Medicare requires that at least 60% of all patients admitted to IRFs have at least one of 13 pre-determined conditions for that IRF to be eligible for reimbursement. Among the 13 conditions include stroke and hip fracture.
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Elderly patients have more far-reaching needs than just those 13 conditions listed on that Medicare list. An elderly person who suffers a fall needs to be treated so future falls are prevented, and the patient can return to their original functional status and independence. If an elderly patient is simply admitted to a nursing home, their condition will likely worsen irreparably. We have seen too many cases of elderly patients admitted to nursing homes “just temporarily” while recovering, only to spend their remaining days in a poorly-run facility.
The differences between nursing homes and IRF centers are systemic. IRF centers often have support groups and mentor programs that match patients who have faced the same health conditions. For example, a former stroke patient could mentor a current stroke patient currently in an IRF, to serve as a role model for following complex medical regimens and improve quality of life. Mentors share information, help relieve anxiety and isolation, and encourage participation and healing.
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These types of programs are not as readily available in nursing homes, which are more focused on long-term, institutional care. Caring for patients does not end when they leave the hospital; hospitals have the responsibility to make sure patients are supported all the way through to an optimal outcome. Falls are a leading cause of injury among elderly trauma patients; we need to figure out a way to most effectively care for elderly patients after trauma discharge. Nursing homes are not the answer.
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