bedridden patient, family member and doctor in hospital room

The shorter the distance to the nearest hospital, the higher the number of potentially avoidable emergency department (ED) visits among assisted living community residents, a new study has found. 

The findings lend credence to the concern that AL communities may rely too heavily on the ED to provide nonemergent resident care that they do not offer on-site, according to investigators.

The researchers examined claims from 2018 to 2019 for fee-for-service Medicare beneficiaries aged 55 years and older who resided in AL communities. Their analysis included ED visit rates, and ED treat-and-release rates and classified the levels of care needed, such as nonemergent; emergent, primary care treatable; emergent, not primary care treatable; and injury-related. 

Treat-and-release visits higher

Older residents of AL communities located close to a hospital had more ED treat-and-release visits than residents whose communities were based further away from the nearest hospital, they found. 

Notably, distance to the hospital was not associated with higher odds of inpatient admission, which would have indicated “clear clinical need” for a hospital visit, according to research lead Brian E. McGarry, PT, PhD, of the University of Rochester, Rochester, NY. In addition, the findings do not appear to be driven by health status differences or resident characteristics, he and his colleagues added. 

Investing in onsite care

The reasoning behind these care choices may lie in convenience and cost savings, the researchers theorized.

“Shorter distances likely reduce the inconvenience of AL-to-hospital transfers and may therefore make ALs less likely to invest in onsite treatment and diagnostic services that could prevent these avoidable visits,” they wrote.

Yet, overuse of nearby EDs may place residents at unnecessary risk of medical harm due to unneeded transfers and hospital care, while generating wasteful Medicare spending, they cautioned.

“Policy reforms are needed to incentivize AL investment in better onsite clinical services,” they concluded.

The study was published in JAMDA.

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