BOCA RATON —
Thousands of nursing home patients are sent to hospitals unnecessarily every year, a practice that's costly for Medicare and Medicaid and potentially harmful to the patients themselves.
In an effort to keep at least some patients at nursing homes and out of hospitals, Florida Atlantic University last week landed a $1.8 million grant from the National Institutes of Health. The money will pay for a four-year study that will collect data from 100 nursing homes.
It's a high-stakes topic. Needless hospital visits cost Medicare hundreds of millions of dollars a year, said Dr. Joseph Ouslander of FAU's medical school. And a study released Monday by Harvard says Alzheimer's patients who go to the hospital have a higher risk of dying in the year after their hospitalization.
Ouslander also is working on a project to train nursing home workers to recognize when a patient should stay out of the hospital.
That's not an easy call, he acknowledged. In many cases, patients should go to the hospital.
"It's very, very complicated," Ouslander said. "We are not trying to prevent every hospitalization. We're just trying to prevent a small number that are inappropriate."
Hospital visits are expensive, and they can be a bad call for patients. Ouslander offers the example of a 90-year-old nursing home patient with Alzheimer's disease, heart disease and painful joint problems. She develops a cough and a 100-degree fever, and the nursing home staff sends her to the hospital.
During her hospital stay, the patient gets confused, climbs out of bed and breaks her hip. If she had remained at the nursing home, Ouslander said, she likely would have recovered from her cough and fever and set back Medicare a mere $200.
Instead, her hospital stay resulted in a $10,000 bill for Medicare and a broken hip that might not have happened in the nursing home.
"Our goal is to literally save Medicare," Ouslander said. "We keep wasting money, and at the same time not improving care or even harming people. We've got to stop that."
Eric Hall, chief executive of the Alzheimer's Foundation of America, cheered FAU's work. About half the nation's 1.6 million nursing home patients have Alzheimer's, and when those patients become disoriented, belligerent or violent, nursing home workers are too quick to call the ambulance.
"Our experience is that tolerance levels are very low, and their first reaction is to send them to the hospital," Hall said.
The stress of new surroundings can send patients with Alzheimer's into a tailspin, Hall said.
"Imagine someone with little or no grasp of the real, and then moving them from one place to the other," Hall said. "It can become quite troublesome."
Indeed, Harvard researchers say hospital visits can be catastrophic for Alzheimer's patients. The researchers studied 771 Alzheimer's patients who were living at home and found that being hospitalized seemed to increase the chances of Alzheimer's patients moving into a nursing home — or even dying — within the next year. The risk is higher if those patients experience what's called delirium, a state of extra confusion and agitation, during their stay.
It's not clear exactly why, although specialists say delirium is especially bad for an already damaged brain. But the researchers, and independent Alzheimer's experts, agree that caregivers need to know the risk so they can help a loved one with dementia avoid the hospital if at all possible.
"It's a very stressful time, being in the hospital," said lead researcher Dr. Tamara Fong, of the Harvard-affiliated Beth Israel Deaconess Hospital and Hebrew SeniorLife in Boston. Often families tell her, "Dad was never the same after he had that surgery and he was confused."
It's a challenge even for health professionals. Psychiatrist Leslie Fuchs watched in disbelief as her mother, who'd had slowly worsening Alzheimer's for several years, rapidly disintegrated during a stay in a New York City hospital last year.
Relatives had called 911 when Thelma Fuchs, 79, suffered what appeared to be a brief seizure. That problem quickly cleared up but the hospital was reluctant to discharge her with it unexplained. Over a few days, Fuchs became increasingly distraught, tried to sneak into other rooms, and wound up being prescribed some antipsychotic drugs, her daughter recalls.
Leslie Fuchs insisted her mother be sent home, where she calmed down and no longer needed the medications. The family has taken steps for more at-home care in hopes of avoiding future hospitalizations.
"She has to be in an environment that's familiar. She can't make a new memory but her old memories, that's what kind of keeps her together," Leslie Fuchs says. At home, she notes, family members "still are the decision-maker. As soon as you're in an emergency room, you kind of can lose that."