Earlier this year, Cori Woods Solan of Pasadena, Calif., admitted her father to an assisted living facility. After receiving an Alzheimer’s disease diagnosis almost seven years ago, Solan’s father became increasingly irritable, angry, and aggressive.
“We were constantly worried about his behavior,” says 44-year-old Solan, who has a new baby at home. “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.” Then, in November, Solan’s father 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,” says Solan.
While there’s still a perception that hospitals by definition are a safe zone, for many patients even necessary hospitalizations leave them in worse shape than they were before admission. “Hospitals are the worst place for the elderly,” says Geriatrician Robert Stall, MD. A New York Times story cited 20-plus years of research documenting the risks of hospitalization for older adults: patient falls, hospital-acquired infections, delirium (from unfamiliar surroundings and medication interactions), and worsening memory for patients with cognitive complaints.
But with a government and health plan push toward reducing unnecessary hospitalizations, experts say the tide may be changing. Today many seniors can get adequate care where they’re comfortable: In nursing homes.
More than a room with a view, nursing homes increasingly offer 24/7 medical care in addition to changing, cleaning, feeding, and administering drugs to patients. Progressive homes 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,” says Stall. “Many have sub-acute care units that act as step down units from hospitals that were built with input from medical specialists.” So what would typically be day five or six in a hospital becomes day one 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,” says Solan. That’s a huge model shift from the traditional nursing home, which was characterized as a long-term care facility where people go to die.
Another aspect is that nursing homes are more family friendly than hospitals. They’re more likely to engage the family as a part of care. 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.
Unfortunately, change is slow. Despite the federal Centers for Medicare and Medicaid Services’ Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, one-third of nursing homes residents are still admitted to the hospital at least once each year, according to a Forbes report — and half of those costly admissions could be avoided, saving Medicare billions.
Trouble is, many of the nation’s Medicare-certified nursing homes outside of those states are ill equipped to address common medical problems, manage IVs, and communicate with doctors about changes in residents’ health status. In fact, according to the Times story, only five states — Rhode Island, Connecticut, Hawaii, Maryland, and Tennessee — require round-the-clock registered nurses to handle these issues.
When a hospitalization is required, many patients experience significant trauma. “Waiting on a gurney in the emergency department, waiting for a transfer to a bed in the hospital, receiving care from a stranger, all of those things are traumatic for seniors,” says Vincent Mor, PhD, professor of health services policy and practice at Brown University School of Public Health.
To avoid that fate, Solan’s dad resides in assisted living now on a floor devoted to people with memory impairment. He has good days and bad days. Solan? She suffers from daily guilt. “I wish we could do more to help with his everyday care, but the good living facilities are cost-prohibitive,” she says. “It’s awful to finally find a center you like and learn there’s a $5,000 fee to submit paperwork and a $6,000 monthly charge.”
Like Solan, most people don’t have that kind of money to spend on long-term care. “As a society we have some careful belly button gazing to do,” says Mor. Basic medical care for seniors, of course, should be a given.
Interviewing a new long-term residence for your loved one? Ask these five questions:
November 05, 2015
Janet O’Dell, RN