Hospitalization for an acute event such as a stroke or hip fracture can lead to a long-term institutionalization in a nursing home, according to a national study. Researchers also found direct discharge to a skilled nursing facility — a common practice designed to reduce hospital stays — puts patients at "extremely high risk" of needing long-term nursing home care.

According to researchers at the University of Texas Medical Branch in Galveston, these findings suggest programs aimed at helping older patients recuperate successfully at home instead of in an institutional setting could greatly improve their health outcomes and reduce healthcare costs.

"Hospitalization is a tipping point for older patients, often reducing their ability to live as independently as before," said lead author James S. Goodwin, MD, director of the Sealy Center on Aging at UTMB.

Medicare pays 100% for 20 days at a skilled nursing facility for patients who have just been released from the hospital but still need extra care. "There is a very narrowly defined view of what Medicare will provide post-hospital," Goodwin said. "If Medicare payment guidelines were broadened to cover in-home care — bathing and food preparation, for example — there is a tremendous potential for savings, and patients could adjust gradually back to their familiar home environment. Medicare will not pay for the in-home care."

The proportion of hospitalized Medicare patients transferred on discharge increased from 10.8% in 1996 to 16.5% in 2008. The study appeared in the Journals of Gerontology: Series A. •