Caregivers must be alert to spot dubious hospitalizations in assisted care residents with dementia

As low as you can go

If you have a loved one in assisted living, there are so many things to worry about.

Most of us worry that they are being neglected or mistreated.

But now there’s another issue we need to worry about. And it’s something most people would never imagine. What if your family member is OVER treated?

Of course, at times, urgent care might seem necessary. But in some cases, it’s completely despicable. It puts helpless patients at risk for the worst possible reason.

Let me explain…

One for the money

Recently, researchers examined the issue of burdensome transfer (BT).

A BT uproots a patient from nursing home to hospital. As you can imagine, this experience can be very disorienting.

Researchers examined Medicare records for almost 475,000 patients. Each patient had advanced dementia. And each lived in a nursing home for at least 120 days prior to death.

Results…

• Nearly 20% had at least one BT during the last 90 days of life
• Patients who experienced a BT were more likely to suffer trauma
• They were also more likely to require intensive care

In many of these cases, “burdensome” is also “suspicious.” Doctors consider patients with advanced dementia to be terminal. So moving them for less than a major medical emergency is disgraceful.

Disgraceful and then some. Here’s why…

Medicaid pays about $200 per day for assisted-living care of a dementia patient. But those payments increase if patients are moved to a hospital, then back to the nursing home.

So in a nutshell, nursing home administrators have an incentive to hospitalize patients.

Imagine a disoriented patient who represents a cash “incentive.” That’s about as low as you can go.

One thing you can do

This study also reveals an important detail for caregivers.

BTs were less common among patients with advance directives in place. These directives are guidelines for nursing home staff.

One official suggested that caregivers should develop relationships with nursing home staff. This ensures that everyone understands the goals of care.

As I mentioned above, most of these patients are terminal. It’s painfully sad, but a difficult advance directive is often the kindest care for a dementia patient. And at least it might help avoid a dangerous transfer.

Sources: 

“End-of-Life Transitions among Nursing Home Residents with Cognitive Issues” New England Journal of Medicine, Vol. 365, No. 13, 9/29/11, nejm.org

“Dementia patients suffer dubious hospitalizations” Marilynn Marchione, Associated Press, 9/28/11, ap.org