Long-term care patients in acute care beds: a community-based analysis

Hospital patients who are ready to be discharged into long-term facilities, such as nursing homes, often remain in acute care hospital beds because long-term care beds are unavailable. Known as 'alternate care patients', they cannot be discharged to home, and create what is known as 'the blocked bed.' There are financial implications of alternate care patients for hospitals; the introduction of prospective payment systems from Medicare and some insurance companies provide for a certain amount of money per admission regardless of length of stay. The reduced access to acute care beds is also a problem. The present study looked at data on the alternate care population in four general hospitals over a three-year period. The hospitals began a collaborative effort to collect data on alternate care in response to the growing problem. Data included length of alternate care stay, patient age, payor status, level of disability, and patient disposition when released from alternate care. Using this data, the growth of the alternate care phenomenon was analyzed, and a comparison was made between hospital patients aged 65 and over who were not placed in alternate care and patients who were placed in alternate care before discharge. Patients placed in alternate care were generally older than those discharged directly from acute care, and with increasing age the use of alternate care increased. The alternate care patient was also more likely to have Medicaid or to be self-paying than the discharged patient. More alternate care patients were discharged to nursing homes (46.1 to 54.1 percent) than to other destinations following alternate care, and 11.2 percent to 14.6 percent were eventually discharged to home from the hospital. Approximately 14 percent of the beds in the four hospitals were considered alternate care beds during the three-year period studied. One solution to the problem of blocked acute care beds would be to increase the number of nursing home beds in the community. Other changes are possible as well. Overall, there is a need for programs designed to meet the needs of this elderly, alternate care population, so that valuable acute care beds are available to the patients who need them. Hopefully, data such as provided in this study will stimulate thought as to how to accomplish this. (Consumer Summary produced by Reliance Medical Information, Inc.)