Alzheimer's Patients in Nursing Homes May Suffer Prolonged Demise


May 2, 2013

A disturbing trend has surfaced recently, according to Dr. Joan Teno from Brown University. It seems that 20 percent of nursing home patients on Medicare who have advanced Alzheimer's dementia were dispatched to hospitals and nursing homes during their last few months, which effectively ran up their bill to the taxpayers. Not only are their charges increased, their demise is prolonged via expensive intensive care and tube feeding.

When an elderly patient comes down with pneumonia, infections or problems swallowing, assisted living centers and nursing homes might believe hospital care is necessary. However, money may be the chief motivator for the transfer since Medicare pays 300 percent more than the standard rate per day to treat patients who have recently been hospitalized.

Teno said she wonders if the care is necessary and if the system is doing the best for the patient. She said, "A lot of this care just feels like in and out, in and out." Teno was one of several researchers from Harvard and Dartmouth who co-authored a study that was published in the New England Journal of Medicine.

Out of some 475,000 patients included in the study, nearly 20 percent were placed in hospitals for dubious reasons. While there was no direct evidence that money was the motivating factor, researchers said that the high variation from state-to-state suggested that money might be the deciding factor.

For example, transfers from Alaska and Alabama were 2 percent as compared to 37 percent. Twenty-six percent of Texas residents had numerous urinary infections, dehydration or pneumonia. These conditions are usually handled within a nursing home. In Grand Junction, Colorado, that rate is only one percent. Records from 2000 to 2007 were used to find what were referred to as burdensome transitions of care, such as moving patients numerous times during their last ninety days of life, moving patients so they went to a new nursing home after hospitalization and moving patient during their last three days of life,

Normally, Medicaid pays $175 per day for long term care, but the rate triples when a patient returns from a stay in the hospital and requires skilled nursing care. This provides nursing homes that operate on a margin to significantly add to their annual revenue, said Teno.

Studies showed that patients with a questionable transfer were more likely to be enrolled in a hospice within three days before their death, to have bedsores, to spend time in intensive care during their last 30 days of life or to have a feeding tube inserted. Black and Hispanic patients suffered more dubious transfers than white patients, as were people without living wills or advance directives.

This research is crucial because over 1.6 million old folks reside in nursing homes, and almost 25 percent were admitted to a hospital within a month of being admitted to a nursing home because the home fear legal action if they don't treat an ill patient.