Nursing homes transferring advanced dementia residents to hospitals for questionable reasons, study suggests

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Chances of peaceful death are three times higher for dementia residents with an advance directive, s
Chances of peaceful death are three times higher for dementia residents with an advance directive, s
The rate of questionable transfers of end-stage dementia patients from nursing homes to hospitals has raised red flags, according to researchers.

Long-term care facilities often move advanced dementia patients to hospitals when problems with swallowing, pneumonia or infections arise. But after analyzing Medicare records of nearly 475,000 patients, researchers, led by Brown University's Joan Teno, M.D., found 19% were transferred for questionable reasons. Investigators also observed a wide variation in the rate of transfers from state to state. Although the data show no evidence of wrongdoing, the investigators suspect money and reimbursements could be playing a role.

Teno says that such transfers can be burdensome for the patients and hasten the depletion of Medicare-reimbursed care. While Medicaid pays $175 per day for care, in one example, Medicare pays three times that when a resident is transferred back to a nursing home after a hospitalization lasting three days or more, the Associated Press reported.

“These transitions reflect the inefficiency of our health care system,” said Teno in a statement. “Similar outcomes could be achieved by keeping these patients in the nursing home setting.”

The study was published Thursday in the New England Journal of Medicine.
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