Assisted living communities located close to hospitals are more likely to rely on emergency departments to provide non-emergency primary care rather than invest in onsite or on-call medical staff, according to a study in JAMDA, the journal of AMDA–The Society for Post-Acute and Long-Term Care Medicine.
Researchers led by Brian E. McGarry, PT, PhD, from the University of Rochester, used the distance between assisted living communities and nearby hospitals to examine resident rates of ED use. They found that the closer the community was to a hospital, the more likely it turned to the local ED for diagnostic and medical care services when a resident’s medical provider was unavailable.
Those ED transfers were seen as disruptive and potentially harmful, increasing resident risk for unnecessary hospitalizations, development of delirium and potential medical mistakes, as well as wasteful Medicare spending, according to the authors.
Prior research shows that half of beneficiaries in the traditional Medicare who live in an assisted living community visit the ED at least once a year, and more than one fourth are hospitalized. Lower non-financial costs for assisted living communities located close to hospitals — ambulance response time, travel time and resident burden — make the communities and their staff members more willing to rely on hospital EDs to provide fast, non-emergency medical care and less likely to invest in any onsite primary care or training capabilities, the authors wrote.
“Shorter distances likely reduce the inconvenience of AL-to-hospital transfers and may, therefore, make ALs less likely to invest in onsite treatment and diagnostic services that could prevent these avoidable visits,” the authors wrote. “Coupled with a desire to avoid legal liability for making clinical decisions regarding resident care needs, the use of nearby hospitals as a substitute for primary care may be a much more economically attractive option for AL operators.”
Telemedicine and shared decision-making between paramedics and primary care physicians has shown promise in reducing those transfers, according to the authors. Also, interest is growing in increasing the clinical capabilities of assisted living communities by hiring nurses, nurse practitioners and physician assistants, as well as establishing a medical director position. But those potential interventions would require a significant financial investment by communities, which have little incentive to incur the costs.
Researchers said state-level policy reforms, including increased staffing and/or admission and retention requirements for assisted living communities, or creative payments models to allow assisted living communities to share in the cost savings of preventing ED visits, will be necessary.
The study was supported by a grant from the US Department of Health and Human Services’ Agency for Healthcare Research and Quality.