Nursing homes vs. hospitals for primary senior care

Another way to reduce unnecessary hospitalizations? A recent New York Times article has kicked off a debate on whether many procedures for older adults can be better delivered in a nursing home or skilled nursing facility (SNF) setting rather than in-patient hospitals. Already serving many seniors for rehabilitation and residential care for multiple chronic conditions and old age-related debilities, the dreaded transfer to hospital may be lessened by a combination of outpatient procedure and installation of 24-hour nursing at these homes. Unbelievably (to this Editor) many of the 16,000 nursing homes in the country do not have round-the-clock nursing staff; only five states require 24/7 registered nurse coverage on site and there is no Federal requirement. An advantage is that minimizing hospital stay also minimizes hospital-acquired infections, patient distress at being taken out of familiar surroundings and cognitive loss. Another is cost. Medicare and Medicaid pay fixed daily amounts to nursing homes per resident which are far lower than hospitals. However the downside is that most nursing homes and SNFs without endowment (unlike the profiled, well-funded and large Hebrew Home and Gurwin in New York) cannot provide higher levels of nursing services for a high-cost patient on the current payment level. Changes in both systems, in compensation, inspection and nursing homes revamping to provide a higher level of care, are needed–as well as passive vital sign and remote behavioral monitoring not mentioned in either article. Also FierceHealthcare



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