Intensity of Care Varies for Patients With Advanced Dementia Across Regional NHs

In a recent study released by The Journal of Post-Acute and Long-Term Care Medicine, researchers noted the intensity of care such as hospital transfers and tube feeding of residents with advanced dementia varies by nursing home (NH) within and across regions.

Previously, little data examined the correlation between intensity of care and the NH region. This study’s objectives were to identify facility factors associated with NHs providing high intensity care to residents with advanced dementia and determine whether these factors differ within and across hospital referral regions (HRRs).

The final study cohort included 1449 NHs. The Nationwide 2016-2017 Minimum Data Set was used to categorize NHS and HRRs into 4 levels of care intensity based on rates of hospital transfers and tube feeding among residents with advanced dementia: low intensity NH in a low intensity HRR; high-intensity NH in a low-intensity HRR; low-intensity NH in a high-intensity HRR; and a high-intensity NH in a high-intensity HRR.

According to the study’s results, in high-intensity HRRs, high- vs low-intensity NHs were more likely to be urban, lack a dementia unit, have a nurse practitioner (NP) or physician on staff, and have a higher proportion of residents who were male, aged 65 years or younger, Black, had pressure ulcers, and shorter hospice stays. In low-intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high-intensity NH.

“These findings suggest that within high-intensity HRRs, there are potentially modifiable factors that could be targeted to reduce burdensome care in advanced dementia, including having a dementia unit, palliative care training for NPs and [physicians], and increased use of hospice care,” the authors concluded.

Reference:
Hendricksen M, Mitchell S, Lopez R, Mazor K, McCarthy E. Facility characteristics associated with intensity of care of nursing homes and hospital referral regions [published online ahead of print November 23, 2021]. J Am Med Dir Assoc. doi:10.1016/j.jamda.2021.10.015