The number of patients 85 and older who are hospitalized with dementia is going up fast. But often the hospital isn't necessarily where they belong, suggesting an opportunity for home health and skilled nursing providers.
A study out of the University of Massachusetts at Amherst, published in the Archives of Internal Medicine, estimates that between 2000 and 2008, the annual number of Americans 85 and older who were hospitalized with dementia rose from 700,000 to 1.2 million annually, or to about 21% of the 85+ population. In a follow-up letter to the journal, one researcher speculated that by 2050, at that rate, there will be three to seven million dementia hospitalizations a year.
Given the medical community's professed desire to cut down on unnecessary hospitalizations, and assuming personnel are trained to recognize the difference between situations that call for a trip to the ER and those that just require careful monitoring, it seems logical to encourage home and skilled nursing facilities (SMF)treatment for dementia patients.
While the UMass researcher, Dr. Marya Zilberberg, declined to make alternate care recommendations, she told Reuters that "there should be more care taken in terms of their comfort and in terms of appropriate and timely end-of-life discussion and measures and support of the family."
Elderly dementia sufferers normally go to the hospital for non-dementia-related illnesses, some of which might be equally well-treated at an elder care facility or even at home. Reuters says Zilberberg and another expert agree that, because of the way Medicare compensates for treatment, "nursing facilities have more of an incentive to send those patients to acute care, rather than to handle the cases themselves."
McKnight's Long-Term Care News reads this as "nursing homes better for handling dementia patients, study suggests." While that may be a reach, SNF are among the logical alternatives. So may be home health care: The American Health Assistance Fondation says that 70% of Alzheimer's sufferers receive care at home. And experts such as the National Institute on Aging list home health, assisted living, and palliative care services among the appropriate treatments for such patients with dementia.
Update. A reader who works in management at a large multi-specialty health organization writes to tell us that "home health is a great place for this type of patient, if they have a skilled need -- unless a home health agency has a psychiatric nurse on board, we really cannot admit just for dementia." She says hospice can more easily admit dementia patients, as "there is usually a co-morbidity that helps drive that disease process... personal care in the home is always an option -- but it is pricey."
(We're always happy to hear from readers -- drop us a line here.)