Inpatient Care for Nursing Home Patients: An Opportunity to Improve Transitional Care

Elderly residents of long-term care facilities are often afflicted with multiple medical, psychological, and social problems resulting in frequent transfers to the acute care hospital for various complex needs. Many of these transfers are inappropriate.⁸ During transfers between the long-term care facility and the acute care facility, this population is particularly vulnerable to experiencing poor quality and fragmented care. Repeated transfers are common and have been described as a “ping-pong” pattern, and are known to have negative effects on health. One study of the 2-year follow-up period after transfer between facilities that had both skilled nursing and intermediate care components noted that 19% of residents from skilled nursing facilities and 42% of residents from intermediate care facilities had 1 extra hospitalization. Furthermore, 8% of residents from skilled nursing facilities and 13% of residents from intermediate care facilities had more than 2 extra hospitalizations.¹ Despite how common these transitions have become, the challenges of improving the process of transitional care have only begun to receive attention from policy makers, clinicians, and quality improvement entities.