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Older Adult Transition to Community- and Home-Based Care May Result in Higher Risk of Hospitalization: Study

old-hospital-22A study of older adults transitioning from nursing homes to community or home care suggests that the move resulted in a 40% greater risk of “potentially preventable” hospitalization among those dually eligible for Medicaid and Medicare.

In a news release from Brown University, lead study author Andrea Wysocki, postdoctoral scholar, Brown University School of Public Health, states that while the goal to move older adults back into the community is a good one, “One of the policy issues is how do we care for not only long-term care needs when we move someone into home- and community-based settings but also how do we support their medical needs as well,” Wysocki explains.

The study’s finding of a “higher potentially preventable risk” for older adults transitioned to community- or home-based care, Wysocki maintains, indicates some medical needs may not be as well addressed in community settings as they are in nursing homes. The release states that the reduction of effectiveness in preventing hospitalizations may stem from a variety of sources, including that while Medicaid pays for long-term care, Medicare pays for medical care, allowing home- and community-based care to be less expensive for Medicaid regardless of medical outcome.

During the study, the release reports that Wysocki and her co-authors assessed a set of records provided by the Centers for Medicare and Medicaid Services of thousands of dually eligible older adults from Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington who entered nursing home between 2003 and 2005. The data assisted Wysocki and her team in pinpointing who made the transition to community and home care, and who stayed in the nursing home.

The researchers reportedly compared the rate of hospitalizations among 1,169 older adults who transitioned to the community and 1,169 otherwise similar older adults who stayed in the nursing home. A total of 133 of those who transitioned ended up hospitalized for potentially preventable reasons, the release notes, compared to 113 who stayed. The results also indicate that including “non-preventable” hospitalizations, the numbers increased to 419 among transitioned individuals and 297 among those who stayed.

Wysocki then used a standard statistical technique to account for a time difference in older adults who stayed and who generally took a longer time to reach the first hospitalization than older adults in the transitioner group. The technique revealed that transitioners faced a 40% higher risk of enduring a potentially preventable hospitalization and a 58% greater risk of any kind of hospitalization than those who stayed did.

The study, which appears in the Journal of American Geriatrics Society, emphasizes that ensuring individuals have long-term and medical providers, as well as a care plan at the time of transition, may assist in keeping these individuals out of hospital and bolster more successful long-term outcomes.

Additional study authors include Robert Kane, MD, Bryan Dowd, PhD, Ezra Golberstein, PhD, and Tetyana Shippee, PhD, University of Minnesota School of Public Health, and Terry Lum, PhD, University of Hong Kong.

[Source: Brown University]