Dementia Patients Are More Likely To End Up in Low-Quality Nursing Homes: Study

Although they need more specialized care and are unable to advocate for themselves, new research suggests that dementia patients are more likely to be admitted to lower quality long-term care facilities, where they may face an increased risk of injuries from nursing home neglect.

Medical professionals often divide nursing homes into a two-tiered system, with those in the lower tier usually having more limited resources, and subsequently demonstrating lower quality measures and facing more nursing home negligence lawsuits.

It has also been known for quite some time that nursing homes in the lower tier have more dementia patients than facilities that provide higher quality care. However, the reason for this disparity has not been well understood.

In a new study published last week in Alzheimer’s & Dementia, the journal of the American Alzheimer’s Association, researchers indicate that dementia patients are less likely to be admitted to top tier facilities following a hospital stay, suggesting that this may be the result of higher costs associated with their care, which may negatively impact revenues for the facilities.

The research was led by Cyrus M. Kosar, of the Department of Health Services at Brown University in Providence, Rhode Island, looking at data for traditional Medicare beneficiaries who were discharged from hospitals to nursing homes between 2011 and 2017.

Kosar’s team reviewed both hospital readmission and mortality data for the patients within 30 days and 90 days of their hospital stays. At the same time, they examined which patients were being discharged to high quality homes with available beds that were near the hospitals.

The researchers determined that the probability of being readmitted to the hospital from a higher rated nursing home within 30 or 90 days decreased by 0.81 percentage points for patients with dementia. It decreased by only 0.34 percentage points if the patient did not have dementia.

In addition, higher star ratings corresponded with reduced rates of patient deaths at both the 30 and 90 day marks, indicating that dementia patients are less likely to die or be readmitted to the hospital if they are discharged to a high quality nursing home.

However, even if a greater number of beds were available at high quality nursing homes when patients were discharged from the hospital, the number of dementia patients accepted into those facilities did not change.

This suggests that although dementia patients can benefit from higher quality nursing home care, they are less likely to receive that care, which has led Kosar’s team to conclude that there is a need for better efforts by hospital discharge staff to find high quality care for dementia patients.

The researchers also concluded that additional incentives might be needed to encourage nursing homes to admit dementia patients. These could include different payment mechanisms or better risk adjustment methods.

“Incentivizing nursing homes to treat patients with dementia is another potential avenue for reform. Historically, nursing homes have been reimbursed based on the level of skilled therapies provided with rudimentary case mix adjustment. It is likely that patients with dementia both generate low revenues and also have high ancillary costs associated with their care,” Kosar said. “Under a different payment mechanism and better risk adjustment, higher-quality nursing homes may find it more worthwhile to serve patients with dementia.”