bedridden patient, family member and doctor in hospital room
(Credit: Luis Alvarez / Getty Images)

The shorter the distance to the nearest hospital, the higher the number of potentially avoidable emergency department visits among assisted living community residents, a new study has found. 

The findings lend credence to the concern that assisted living communities may rely too heavily on the ED to provide nonemergent resident care that they do not offer on-site, according to the investigators.

The researchers used claims from 2018 to 2019 for fee-for-service Medicare beneficiaries aged 55 years and older who resided in assisted living communities. They analyzed ED visit rates, ED treat-and-release rates and classified the levels of care needed, such as nonemergent; emergent, primary care treatable; emergent, not primary care treatable; and injury-related. 

Treat-and-release visits higher

Older residents of assisted living communities located close to a hospital had more ED treat-and-release visits than did residents whose communities were based further away from the nearest hospital, they found. 

Notably, distance to the hospital was not associated with higher odds of inpatient admission, which would have indicated “clear clinical need” for a hospital visit, according to research lead Brian E. McGarry, PT, PhD, of the University of Rochester, Rochester, NY. In addition, the findings do not appear to be driven by health status differences or resident characteristics, he and his colleagues added. 

Investing in onsite care

The reasoning behind those care choices may lie in convenience and cost savings, the researchers theorized.

“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,” they wrote.

Yet overuse of nearby EDs may place residents at unnecessary risk of medical harm due to unneeded transfers and hospital care, while generating wasteful Medicare spending, they cautioned.

“Policy reforms are needed to incentivize AL investment in better onsite clinical services,” they concluded.

The study was published in JAMDA, The Journal of Post-Acute and Long-Term Care Medicine.

This article originally appeared on McKnight's Long-Term Care News