For many nursing home residents, a visit to the hospital can be a shocking experience; one that leaves them confused and stressed. Yet preventable transfers happen far too often, not only disrupting a resident’s routine but costing the U.S. health care system $2.6 billion annually.
When researchers at the University of Missouri recently looked at the decision-making process about whether to transfer nursing home residents to the hospital, they quickly discovered that it is complicated: especially for residents with cognitive impairment who may not be able to express their preferences.
Kimberly Powell, assistant professor at the Sinclair School of Nursing, led a recent study that found that nursing home residents with Alzheimer’s disease or related dementias had higher rates of avoidable transfers to the hospital than residents without dementia. These transfers often resulted from a discrepancy between the care provided and the personal preferences of the residents.
Powell pointed to the increasingly popular Age-Friendly Health System Initiative, which focuses on tailoring care to what matters most to patients, emphasizing patients’ 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. Therefore, our study highlights the importance of documenting advance care planning for residents in advance. Who have conversations early and often -; ideally when a resident is at an earlier stage of disease progression and is better able to communicate their wishes and values; helps us honor them for the rest of 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 the Centers for Medicare and Medicaid that embedded advanced practice registered nurses full-time in 16 Missouri nursing homes with higher hospitalization rates than the national average.
“For people with a progressive disease like Alzheimer’s or dementia, we often find that they value dignity in later life and being in a place that is comfortable while surrounded by people they know and love,” said Powell. “We have also found that increasing the support, training and resources of nursing home staff can help residents get the care they need as they age, while they remain in the nursing home. Ultimately, we want to better the staff who work in nursing homes to support.”
Ashley Woods, a doctoral candidate at the Sinclair School of Nursing and a nurse practitioner at a New Mexico hospital, encounters the problem firsthand.
“Sometimes patients’ forms are marked ‘do not transfer,’ so there seems to be some disagreement about the best course of action,” she said. “People with dementia may experience a temporary episode of anxiety in the nursing home, but by The time I see them in the hospital, everything looks fine. Yet the transfers are often a traumatic and stressful experience for the residents and they often do not match the patient’s priorities and goals.”
Woods’ research, supervised by Powell, builds on the findings by examining how often nursing home care teams address pain in residents with dementia.
“The work Ashley does around pain is so important and clinically meaningful,” Powell said. “Two-thirds of nursing home residents have cognitive disabilities, and that number is only expected to increase in the coming years, so this will become an increasingly relevant topic to monitor in the future. Ultimately, we want the nursing home to put the residents’ goals, values and preferences above everything else.”
‘Disentangling the complex web of avoidable nursing home-to-hospital movements of residents with dementia’ was published in Alzheimer’s and dementia. Funding for the research was provided by the National Institutes of Health. The interdisciplinary research team included staff from the School of Medicine, the College of Arts and Science and the MU Institute for Data Science and Informatics.
Mizzou; a leading research university and member of the prestigious Association for American Universities -; has a strong track record in investigating preventable hospital admissions, including:
1. A $1 million grant Powell earned in 2022 from the National Institutes of Health to see if text messaging could be used by nursing home staff to speed up decision-making and prevent the decline in residents’ health to ultimately reduce avoidable hospital transfers.
2. A 2022 study funded by the Centers for Medicare and Medicaid found that Black nursing home residents and people under the age of 65 are more likely to have repeat hospital transfers.
3. A 2021 study found that nursing homes in Missouri saved $32 million by reducing preventable hospitalizations.
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Magazine reference:
Powell, K.R., et al. (2024). Disentangling the complex web of avoidable nursing home-to-hospital movements of residents with dementia. Alzheimer’s & Dementia. doi.org/10.1002/alz.14292.