Preventable Nursing Home Hospitalizations Drive up Health Care Costs

October 11, 2011

Our Illinois medical malpractice attorneys strongly advocate on behalf of our clients for quality nursing home care. We understand that in the long run, high quality care is less costly and more effective at maintaining or improving a patient's overall quality of life. A new study in the New England Journal of Medicine illustrates the problem of avoidable hospitalizations and the financial incentives behind them that are leading to higher healthcare costs and poor health outcomes.

According to the study, conducted by researchers from Harvard University, Brown University, and Dartmouth Medical School, a significant number of hospitalizations can be avoided with better communication and care among workers in Illinois nursing homes and nursing homes around the country. In fact, it has been estimated that nearly half of all hospitalizations of long-stay nursing home residents are potentially avoidable.

Unfortunately, the study also points out that nursing homes have a financial incentive to hospitalize patients, ultimately leading to unnecessary complications and expenditures. Medicaid and private insurance typically pay for nursing home care, while Medicare covers hospital care. Medicare may also cover the cost of rehabilitation at the facility for a limited period of time after hospitalization, at a much higher rate than Medicaid. This creates an incentive for nursing homes to transfer sick residents to the hospital, where Medicare will absorb the costs. Researchers found that approximately one fifth of Medicaid nursing home residents suffering from Alzheimer's or dementia were transferred to hospitals for questionable reasons during the last 4 months of their life.

Unnecessarily hospitalizing nursing home residents creates a financial burden for taxpayers, because Medicare hospital benefits are funded by our payroll taxes. Medicare is paying significant costs for nursing home residents suffering from complications such as bedsores or feeding tube insertions who could be effectively treated without a hospital transfer. Many times, hospitalizing elderly patients actually results in further complications because these patients are vulnerable to infections that can occur in a hospital setting. Studies also show that elderly patients often become confused and experience a decline in functional status when they are transferred to a hospital.

Illinois medical malpractice attorneys at Pintas & Mullins Law Firm know that it is critical to provide nursing home residents with the quality care they need. There are times when hospitalization is necessary, because some complications cannot be managed by a facility, especially those that are underfunded or understaffed. However, hospitalization decisions should be motivated by individual patient needs and facility capabilities, rather than by financial benefits.

The costs and complications associated with avoidable hospitalizations are troubling. It is more expensive to care for residents in the hospital, which drives up federal health care spending. Not only are taxpayers suffering the consequences, but vulnerable nursing home residents are suffering poorer health outcomes as a result. We have worked with many nursing home victims and their families who have been affected by poor quality nursing home care. You should be able to trust that your loved one is getting the care that they need and deserve in a nursing home. When a nursing home or assisted living facility fails to deliver adequate care, a skilled nursing home attorney can explain your legal rights and the compensation that you may be entitled to.