Seniors not utilizing cheaper post-hospitalization options: Study

By Allen Cone  |  Feb. 23, 2018 at 2:51 PM
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Feb. 23 (UPI) -- Less expensive care options for seniors recovering from severe and complex illnesses after hospitalization are not being utilized, according to researchers in Texas.

Researchers at the University of Texas Southwestern's Center for Patient-Centered Outcomes Research in Dallas examined Medicare data for 65,525 hospitalized adults over 65 receiving a tracheostomy -- a surgically inserted hole in the windpipe -- from 2010 to 2012. The findings were published this month in JAMA Internal Medicine.

Fifty-two percent of the patients were transferred to long-term acute care facilities because of the severity or complexity of their illnesses compared with 15 percent based on hospitals and 33 percent on regional factors.

"We found that many older adults are being sent to LTACs based on the preference of hospital providers and regional availability, when they may potentially be cared for as effectively in other, less expensive post-acute care settings, such as skilled nursing facilities," said lead author Dr. Anil Makam, assistant professor of Internal Medicine at UT Southwestern Medical Center in Dallas in a press release.

Post-acute care by hospitalized older adults has increased by 50 percent over 15 years, according to a National Hospital Discharge Survey and represents the largest increase in Medicare spending, according to a previous study.

"The extreme regional differences in long-term acute care use across the country suggest that there is overuse of LTACs in the South, including the Dallas-Fort Worth Metroplex, and possibly underuse of LTACs in the Pacific Northwest, the North, and the North Northeast," Makam said. "Nonetheless, geography is not entirely destiny, since hospitals located within the same region use LTACs very differently."

Despite these findings, researchers say that more research is needed to better understand when a long-term facility is a preferable option for patients.

"A key challenge is that no one knows what the right rate of LTAC use is, or even who the right person is to transfer to an LTAC," Makam said.

"There are some people who we know clearly benefit from long-term acute care services, such as those recovering from certain critical illnesses, but there are also a lot of grey areas that we're not sure about. It is critical that we understand which individuals are most likely to benefit from LTACs for post-acute care so that we can make the smartest decisions about how to best use these resources to help older adults recover."

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