For many nursing home residents, a trip to the hospital can be a jarring experience -; one that leaves them confused and stressed. Yet avoidable transfers happen far too often, not only disrupting a resident’s routine but also costing the U.S. healthcare system $2.6 billion annually.
When researchers at the University of Missouri recently looked at the decision-making process for whether or not to transfer nursing home residents to the hospital, they quickly discovered that it’s complicated -; particularly for residents with cognitive impairment who may not be able to communicate their preferences.
Kimberly Powell, an assistant professor in the Sinclair School of Nursing, led a recent study that found nursing home residents with Alzheimer’s disease or related dementias were more likely to have avoidable transfers to the hospital compared to residents without dementia. These transfers often stemmed from a mismatch between the care provided and the residents’ personal preference.
Powell pointed to the increasingly popular Age-Friendly Health System Initiative, which focuses on aligning care with what matters most to patients, emphasizing patients’ wishes and minimizing trauma and risk.
Not all residents with dementia can tell the nursing home staff they don’t want to be transferred to the hospital, so our research highlights the importance of documenting advanced care planning for residents ahead of time. Having those conversations early and often -; ideally when a resident might be in an earlier stage of disease progression and better able to communicate their desires and values -; helps us honor them through the rest of their life.”
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 into 16 Missouri nursing homes with higher hospitalization rates than the national average.
“For those with a progressive disease like Alzheimer’s or dementia, we often find that they value having dignity later in life and being in a place that is comfortable while surrounded by people they know and love,” Powell said. “We also found that increasing nursing home staff support, training and resources can help residents receive the care they need as they age while remaining in the nursing home. We ultimately want to better support the staff who work in nursing homes.”
Ashley Woods, a doctoral student in the Sinclair School of Nursing and nurse practitioner at a hospital in New Mexico, encounters the issue firsthand.
“Sometimes, the patients’ forms are marked ‘do-not-transfer,’ so there seems to be a disconnect about the best course of action,” she said. “Those with dementia may experience a temporary episode of agitation in the nursing home, but by the time I see them in the hospital, everything looks good. Still, the transfers are often a traumatic and stressful experience for the residents and they don’t often align with the priorities and goals of the patient.”
Mentored by Powell, Woods’ research builds on the findings by exploring how frequently nursing home care teams address pain in residents with dementia.
“The work Ashley is doing around pain is so important and clinically meaningful,” Powell said. “Two-thirds of nursing home residents have cognitive impairment, and that number is only projected to grow in the years ahead, so this will become an increasingly relevant topic to monitor going forward. At the end of the day, we want the nursing home residents’ goals, values and preferences to be put ahead of anything else.”
“Untangling the complex web of avoidable nursing home-to-hospital transfers of residents with dementia” was published in Alzheimer’s & Dementia. Funding for the study was provided by the National Institutes of Health. The interdisciplinary research team included collaborators from the School of Medicine, 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 researching avoidable hospitalizations, including:
1. A $1 million grant Powell earned in 2022 from the National Institutes of Health to see whether texting could be used by nursing home staff to speed up decision-making and prevent the decline of residents’ health to ultimately reduce avoidable hospital transfers.
2. A 2022 study funded by the Centers for Medicare and Medicaid that found Black nursing home residents and those under age 65 are more likely to have repeat transfers to the hospital.
3. A 2021 study that found Missouri nursing homes saved $32 million by reducing avoidable hospitalizations.
Source:
Journal reference:
Powell, K. R., et al. (2024). Untangling the complex web of avoidable nursing home‐to‐hospital transfers of residents with dementia. Alzheimer S & Dementia. doi.org/10.1002/alz.14292.
