For many nursing home residents, a trip to the hospital can be a frightening experience -? which leaves them confused and stressed. However, preventable transfers occur far too often, not only disrupting a resident’s routine but also costing the US health care system $2.6 billion annually.
When researchers at the University of Missouri recently looked at the decision-making process of whether or not to transfer nursing home residents to the hospital, they quickly discovered that it’s complicated -. particularly for residents with cognitive disabilities who may not be able to express their preferences.
Kimberly Powell, an assistant professor in the Sinclair School of Nursing, led a recent study that found nursing home residents with Alzheimer’s disease or related dementias were more likely to have avoided hospital transfers compared to residents without dementia. These transfers often stemmed from a mismatch between the care provided and the residents’ personal preference.
Powell pointed to the increasingly popular Age-Friendly Health System Initiative, which focuses on aligning care with what matters most to patients, emphasizing patient wishes and minimizing trauma and risk.
Not all residents with dementia can tell nursing home staff that they do not want to be transferred to hospital, so our research highlights the importance of early documentation of advanced care planning for residents. Having these conversations early and often -? ideally when a resident may be at an earlier stage of disease progression and better able to communicate their wishes and values - it helps us honor them throughout their lives.”
Kimberly Powell, assistant professor, Sinclair School of Nursing
For the study, Powell and her team analyzed data from the Missouri Quality Initiative, a $35 million program funded by Cents for Medicare and Medicaid that integrated full-time advanced medical registered nurses into 16 Missouri nursing homes with hospitalization rates higher than the national average.
“For those with a progressive disease like Alzheimer’s or dementia, we often find that they appreciate having dignity later in life and being in a place that is comfortable while surrounded by people they know and love,” Powell said. “We also found that increasing support, training and resources for nursing home staff can help residents get the care they need as they age while still in the nursing home. Ultimately we want to better support staff working in nursing homes.”
Ashley Woods, a doctoral student at the Sinclair School of Nursing and a nurse at a hospital in New Mexico, is experiencing the problem firsthand.
“Sometimes patients’ forms say ‘not transferring,’ so there seems to be a disconnect about the best course of action,” he said. “Those with dementia may experience a temporary episode of agitation in the nursing home, but by the time I see them in hospital, everything seems fine. However, transfers are often a traumatic and stressful experience for residents and do not often align with the patient’s priorities and goals.”
With Powell’s guidance, Woods’ research builds on findings by investigating how often nursing home care teams address pain in residents with dementia.
“The work that Ashley is doing around pain is so important and clinically important,” Powell said. “Two-thirds of nursing home residents have cognitive impairment, and this number is only projected to increase in the coming years, so this will become an increasingly relevant issue to monitor in the future. At the end of the day, we want the nursing home’s goals, values and the preferences of the residents to come before anything else.”
“Untangling the complex web of avoidable home-to-hospital nursing transfers of residents with dementia” was published in Alzheimer’s & Dementia. Funding for the study was provided by the National Institutes of Health. The interdisciplinary research team included collaborators from the School of Medicine, the College of Arts and Sciences, and the MU Institute for Data Science and Informatics.
Mizzou -? leading research university and member of the prestigious Association of American Universities – has a strong track record of researching preventable hospitalizations, including:
1. A $1 million grant Powell won in 2022 from the National Institutes of Health to see if texting could be used by nursing home staff to speed decision-making and prevent residents from deteriorating , ultimately reducing avoidable hospital transports.
2. A 2022 study funded by the Centers for Medicare and Medicaid found that Black nursing home residents and people under 65 are more likely to have repeat hospital transfers.
3. A 2021 study found that Missouri nursing homes saved $32 million by reducing avoidable hospitalizations.
Source:
Journal Reference:
Powell, KR, et al. (2024). Untangling the complex web of avoidable home-to-hospital nursing transfers of residents with dementia. Alzheimer S & Dementia. doi.org/10.1002/alz.14292.
