About 20 percent of hospitalized Medicare patients are transferred to a skilled nursing facility, also known as a nursing home. Now a recent analysis has found that about half of them don’t get an initial assessment by a medical professional within one day of their admission—and more than 10 percent fall through the cracks completely, receiving no initial evaluation at all.
In the study, published in Health Affairs, researchers analyzed more than 2 million cases of Medicare patients discharged from hospitals to SNFs from January 2012 to October 2014. About half of them were evaluated by a doctor, nurse practitioner, or physician’s assistant within one day of their admission, and 80 percent were assessed within their first four days of transfer. But more than 10 percent weren’t assessed at all during their first 30 days at the facility. Patients who were older, had difficulty performing routine acts of daily living, and had cognitive difficulties were less likely to be visited by a doctor than younger, less impaired patients.
Delaying medical assessments leaves people in nursing facilities more vulnerable to poor outcomes, the researchers wrote. Indeed, patients in the study who didn’t receive assessments within 30 days were twice as likely as patients who were assessed to be readmitted to the hospital (29 vs. 14 percent) or die (14 vs. 7 percent).
What you should do
If you are selecting a skilled nursing facility for yourself or a loved one, consider asking what the average wait time is for seeing a doctor for a medical evaluation. Of course, that’s just one of many factors that could affect health outcomes. Medicare provides a checklist of questions to ask when choosing a facility on its Nursing Home Compare website.
This article first appeared in the August 2019 issue of UC Berkeley Health After 50.
Also see Elder Abuse: A Growing Problem.