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Twenty Percent of Patients with Advanced Dementia Face Unnecessary Hospitalization

Researchers at Harvard University and Dartmouth Medical School have found that almost 20% of nursing home residents with advanced dementia, like Alzheimer’s, were transferred to other care facilities or hospitals in the months before they died. The treatment resulting from these transfers often included harsh measures that may have extended their suffering. While adequate care for these patients does become difficult as they enter the end stages of their disease, the people who conducted this study believe the real reasons for the transfers may be monetary. If a nursing home takes back a patient following a short period of hospitalization, Medicare pays the home around three times the typical amount for care.

The author of the study, Dr. Joan Teno of Brown University, suspects this is a possibility. “I think that’s unfortunately a factor in what’s happening here. […] A lot of this care just feels like in and out, in and out. You really have to question, is the health care system doing a good job or not.”

The research showed that the number of transfers varied quite a bit from state to state, supporting the concern over financial motivation. While Alaska had just 2% of these types of transfers, Louisiana had over 37%. Many hospitalizations were due to simple issues like urinary tract infections or dehydration, and these conditions are most often treatable within the capabilities of nursing homes. Patients were also at an increased likelihood to be fed via a tube, experience a serious bedsore, or be admitted to hospice late (fewer than four days before death).

“This is a population where the burdens of hospitalization often outweigh the possible benefits,” said Teno. “These patients actually do better when they stay in a nursing home.”

The study was published in the September 29 issue of the New England Journal of Medicine. Teno recommends that families who are concerned about the care of their loved ones with dementia can request a “do not hospitalize” order. That way, care options will have to be discussed with the family before any action is taken.

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Lucy is a recent graduate of Western Washington University, majoring in English with an emphasis in Creative Writing. Lucy tagged this post with: , , , Read 7 articles by
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