Elderly/Long-term Care

The decision to hospitalize nursing home residents is driven primarily by residents' preference and quality of life

Moving nursing home residents to a hospital can seriously affect their health. For instance, their often frail conditions make them vulnerable to complications when they are hospitalized. Also, the switch from the nursing home to hospital setting can be disruptive and lead to confusion, disorientation, and further decline. The decision to hospitalize a nursing home resident is driven primarily by the resident's preference, according to a survey of medical directors and directors of nursing (DONs) from 420 (mostly nonprofit) nursing homes in 25 States. The survey was supported by the Agency for Healthcare Research and Quality (HS10645).

Nearly half of medical directors and DONs (46 and 42 percent, respectively) cited resident preference as the most important factor in the hospitalization, followed by residents' quality of life (30 percent and 26 percent), and the amount of discomfort from acute illness (9 and 13 percent). At the time of the hospitalization decision, the most important considerations were resident quality of life, relative effectiveness of treatment options, and family wishes.

The medical directors surveyed cited a lack of information and support to residents and their families regarding end-of-life care as the main factor causing overhospitalization. A secondary factor was covering doctors' lack of familiarity with residents. DONs agreed, but reversed the order. Medical directors and DONs did not attribute overhospitalization to lack of quick access to doctors; however, they ranked on-site doctor/nurse practitioner evaluation within 4 hours as the least accessible resource. The next least available resource that could prevent hospitalization was electrocardiogram tracing and interpretation, followed in order by radiology results in less than 4 hours, laboratory results in less than 4 hours, intravenous therapy, and oxygen monitoring and therapy.

See "Nursing home capabilities and decisions to hospitalize: A survey of medical directors and directors of nursing," by Joan L. Buchanan, Ph.D., Rachel L. Murkofsky, M.D., M.P.H., Alistair James O'Malley, Ph.D., and others in the March 2006 Journal of the American Geriatric Society 54(3), pp. 458-465.

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