Nursing homes merit greater attention in debate about deficit reduction
Dr. Mark Gloth, D.O.
As President Obama and Congress continue to evaluate a multitude of different ways to reduce Medicare spending, it is more important than ever for lawmakers to understand the critical role nursing homes play in providing the specialized care and therapy vital to patient rehabilitation, and central to avoiding costly rehospitalizations.
Within the past decade, nursing homes — more accurately termed as skilled nursing and rehabilitation facilities — have seen a tremendous growth in their patients' medical and clinical complexity. This is because today's healthcare environment dictates that patients be discharged from hospitals at an earlier stage of their healing than 10 years ago. They can still have complex medical issues that can lead to complications and compromise their well-being.
In fact, nearly 25% of all acute care patients are returning to the hospital within 30 days for treatment of their original admitting condition. These “bounce-backs” contribute to rising costs of care; require greater logistical coordination as they re-enter the system; drive up the use of avoidable, unnecessary treatments and procedures; and even hasten patient mortality. Particularly for seniors, a return to the hospital can cause significant physical, physiological and emotional stress, as well.
Instead of re-entering the hospital, however, many post-acute care patients are now able to receive high quality, complex care services at skilled nursing and rehabilitation facilities and then return to home or elsewhere in the community. These centers specialize in post-acute care and understand the unique needs of seniors in particular. And working closely with hospitals and the health plans that pay for care has been a key initiative to improve quality of care, enhance coordination and ultimately reduce rehospitalizations.
Skilled nursing and rehabilitation facilities have positioned themselves as part of the answer for helping to reduce costs, and that fact warrants attention in the context of the deficit-reduction discussion. These dedicated skilled nursing facilities are not the nursing homes of yesteryear; they are 21st century facilities designed to meet 21st century challenges.
Upon arrival at a facility, patients undergo comprehensive health assessments and receive patient-specific plans of care. Coordinated clinical care teams use evidence-based care strategies to address underlying medical issues and improve outcomes. Innovative rehospitalization prevention strategies are integrated within a variety of patient care initiatives, including clinical practice support, infrastructure support (e.g., enhancing access to advanced laboratory and radiology services) and communication tools support.
These strategies, coupled with early medical intervention, are beneficial not just for patients, but for the U.S. taxpayer, as well.
There is a misperception in some quarters that “too much” therapy is being performed in skilled nursing facilities, which downplays the fact that the vast majority of patients we receive have been hospitalized for a minimum of three days. The associated immobility – particularly in medically complex, frail older adults — has wide-ranging negative implications.
Fortunately, the negative consequences of physical immobility can be greatly reduced through aggressive, early intervention with comprehensive rehabilitation including physical, occupational and speech therapy. There is a substantial and growing body of research that shows the benefits of intensive rehabilitation for older adults on a wide variety of problems including sarcopenia (loss of muscle tissue), osteoporosis, cardiopulmonary disease, glucose homeostasis, loss of balance, osteoarthritis, stroke and others. There is also a growing body of literature that shows the benefits of initiating a comprehensive rehabilitation program as early as possible after an acute medical episode. This includes rehabilitation in the intensive care unit (ICU).
Such a dramatic change in the scope and nature of skilled nursing care and services is amplified by 10,000 baby boomers now turning 65 each day. Budget cutters, at the end of the day, must be cognizant of how cuts directed at one healthcare sector can have significant, negative implications to patients, other providers and the stability of our increasingly integrated care continuum.
More than ever, lawmakers should protect Medicare funding for patients requiring the multifaceted care and therapies that can be provided only in America's skilled nursing and rehabilitation centers.
Dr. Mark Gloth is Chief Medical Officer of HCR ManorCare in Toledo, OH.