Receiving a home care visit from a nurse increases the likelihood that an older patient will end up in the emergency department later that day, according to a new study.

Pouring over 2015 home care billing data from Ontario ED visits, Canadian researchers found that those who received a home care visit from a nurse had an increased likelihood of visiting the ED after 5 p.m. that same day. That flies in the face of assertions that boosting homecare might help to alleviate such costly ED trips, according to the study, which was published in the Canadian Medical Association Journal.

Study authors speculate that poor coordination and linkage between home health and other providers could be one reason for these unnecessary ED visits.

Plus, often, such frail elders are dealing with “failure to cope” — or an inability to manage simple daily activities like bathing and dressing — and providers should look to curb their own negative perceptions, and take such issues seriously, the authors wrote.

“We must all remember that social problems are real problems and that those with ‘failure to cope’ require compassionate and thoughtful care just as every other patient does; they are not impositions on our professional lives,” authors concluded.

“These findings are disappointing but not unexpected and serve to remind us that patients who require home-based care are complex,” Allan Detsky, M.D., a coauthor with Mount Sinai Hospital and the University of Toronto, wrote in a related commentary in the same issue of CMAJ. “When community-based nurses are neither integrated into primary care teams nor equipped with resources to manage patients’ problems effectively — perhaps by a limited scope of practice — patients have nowhere else to go but the emergency department.”