Nursing homes transfer about 25% of their residents to the hospital at least once, at a cost to Medicare of $14.3 billion, according to a federal report from the Office of Inspector General.

But a new study from the University of Missouri found that the number of repeat transfers is much higher for black nursing home residents and those younger than 65.

In one of the few studies to analyze the demographics of nursing home residents who are repeatedly transferred to the hospital, Amy Vogelsmeier, an associate professor at the MU Sinclair School of Nursing, found that black nursing home residents nurses, those younger than 65, and those with “full code” status were significantly more likely to be transferred to hospital at least four or more times in a given year.

“Given that repeated hospitalization of nursing home residents can sometimes result in more harm than benefit, we wanted to look back to see if we could identify any patterns to potentially avoid hospital transfer,” Vogelsmeier said. “For example, if a resident becomes very ill and needs to be hospitalized, such as a blood infection due to a urinary tract infection, how can we better prevent the urinary tract infection in the first place? Are there opportunities to better equip nursing homes with the right equipment and trained staff to better manage these conditions without the need for relocation?”

Vogelsmeier and colleagues analyzed a subset of data from the Missouri Quality Initiative, an eight-year, $35 million program funded by the Centers for Medicare and Medicaid that implemented Advanced Practice Registered Nurses (APRNs) full-time at 16 Midwestern nursing homes with higher hospitalization rates. than the national average.

Due to the project’s implementation of APRNs, illnesses were detected early before there was a significant decline in patient condition, which reduced preventable hospitalizations. Yet, from 2017 to 2019, more than 1,400 residents were transferred to the hospital at least once a year, 113 residents were transferred at least four or more times a year, and 17 residents were transferred at least eight or more times. more during the period. three years.

“In addition to the financial burden and adverse health effects like hospital-acquired infections that can occur, transfers from a nursing home to hospital can be traumatic, stressful and frightening for the mental health of frail adults,” said said Vogelsmeier.

Vogelsmeier said young adults can be admitted to nursing homes after traumatic brain injuries or strokes, as well as with serious early-onset conditions, such as congestive heart failure or chronic lung disease. These conditions, combined with potential serious mental disorders, such as schizophrenia and other comorbidities, often require nursing home levels of care for the resident.

“End of life conversations can be difficult, especially with young adults and their families, and sometimes there can be confusion regarding the ‘do not resuscitate’ designation,” Vogelsmeier said. “It just means that no attempt at resuscitation will be made if you die, and does not mean denial of appropriate treatments. We want to focus on evidence-based treatments that are tailored to the resident given their multiple chronic illnesses; knowing that in almost all cases, nursing home residents will die even when cardiopulmonary resuscitation (CPR) is performed and suffer serious harm as a result of the intervention.”

Previous research has shown that black nursing home residents who are transferred to hospital tend to have more chronic conditions, poorer health outcomes and live in lower quality nursing homes, perhaps due to financial constraints.

“Other studies suggest that black residents and their families tend to be less likely to engage in conversations about goals of care and are more likely to seek aggressive treatment, but we don’t yet fully understand why.” said Vogelsmeier. “It could be distrust of the healthcare system, it could be providers assuming they don’t want to discuss these things, which could be rooted in structural racism, so these topics should be investigated. further to better ensure racial equity in health care.”

Vogelsmeier added that APRNs play a critical role in coaching and mentoring nursing home staff, but they were not always sought out or consulted in the decision-making process for study residents who have been transferred several times.

“Whether it’s working with nurses to develop skills or having conversations about difficult goals of care, early APRN involvement plays a key role in guiding appropriate care and reducing potential for avoidable transfers,” Vogelsmeier said. “We have learned from the COVID-19 pandemic just how vulnerable nursing homes are, and greater implementation of APRNs, Registered Nurses and Certified Social Workers in nursing homes can help remedy this. to these vulnerabilities in the future.”

The research has been published in BMC Health Services Research.