Can some physicians/residents chime in?

[sunshine02]

I'm not sure if this is the right place to post here, but I've noticed that many hospitals have 80+ year olds who've been in the hospital for more than 6 months. I was just wondering what the reason is for keeping them that long in the hospital? At least for geriatric care, you want them to be out as soon as possible but 6 months and more makes me wonder if the hospital is being used as a nursing home for them. I'm really curious why.

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[Winged Scapula]

You're correct: acute care hospitals are not for chronic long term care.

As for why you are observing some patients with longer stays, the reasons may be:

- they have an ongoing medical need which cannot be met at other local facilities
- they are not well enough to go home
- they are uninsured/underinsured/have a plan that no long term care facilities will take
- they are not actually there for 6+ months but keep getting readmitted
- they are in a chronic care/LTC/hospice unit of the hospital, not an acute care unit

Placement issues are the bane of any resident physician. Why don't you ask next time you're there? It can actually be a good learning experience for you to see some of the less "glamorous" side of medicine.

(BTW, residents are physicians; your title may be construed as uninformed at best, insulting at worst)

 

[hoihaie]

You should read "being mortal" by atul gawande

 

[NickNaylor]

People aren't kept in the hospital for long periods of time for no reason. You make it sound as if they're being held there for no reason. Older people are typically the sickest patients in the hospital. They have chronic medical problems which start to overwhelm them as they age. An 80 y/o coming into the hospital with a pneumonia is not the same as a 40 y/o coming into the hospital with a pneumonia, and the former is likely to have a more prolonged, complicated medical course than the latter. This is in addition to the reasons @Winged Scapula mentioned above, which are unfortunate pragmatic realities of our lackluster system.

 

[sunshine02]

You should read "being mortal" by atul gawande

Will do thanks!

 

[sunshine02]

Omg yes sorry everyone. Residents are physicians. I can't change the title anymore though

 

[sunshine02]

People aren't kept in the hospital for long periods of time for no reason. You make it sound as if they're being held there for no reason. Older people are typically the sickest patients in the hospital. They have chronic medical problems which start to overwhelm them as they age. An 80 y/o coming into the hospital with a pneumonia is not the same as a 40 y/o coming into the hospital with a pneumonia, and the former is likely to have a more prolonged, complicated medical course than the latter. This is in addition to the reasons @Winged Scapula mentioned above, which are unfortunate pragmatic realities of our lackluster system.

No I didn't mean for it to come across like that. I know there is a reason. That's why I'm asking why they are being kept that long. They aren't being continually readmitted though. Just learned that the patient who had been there for 7 months was just released last week to a nursing home. Is this how it works if they are uninsured or don't have family? The whole thing seems so complex...

 

[Winged Scapula]

No I didn't mean for it to come across like that. I know there is a reason. That's why I'm asking why they are being kept that long. They aren't being continually readmitted though. Just learned that the patient who had been there for 7 months was just released last week to a nursing home. Is this how it works if they are uninsured or don't have family? The whole thing seems so complex...

It is.

The patient in question may have been too unstable for transfer, may have had medical needs which could not be met by local SNFs (some are staffed with barely literate "caregivers"), may not have insurance coverage for long term care, may not have family or family unable to care for them, etc.

 

[LizzyM]

This varies by State. In some States, there just aren't enough nursing home beds and there aren't enough because the State taxpayers end up paying for the care of indigent patients in these nursing homes (and most people become indigent after a couple years in a nursing home if they weren't indigent to begin with) and to keep costs to the State taxpayers under control, the number of nursing home licenses is kept at a level that is artificially low (below the demand). Consequently, someone ready for discharge to a long term care facility won't be able to find an empty bed in such a facility. Thus the long stay in the hospital.

Then there is the long, sad story of Huguette Clark who lived in first one hospital and then another in NYC for over 20 years. She left a fortune of $300 million when she died at the age of 104 and so, one presumes, she paid her hospital bill in cash.

 

[Ismet]

No I didn't mean for it to come across like that. I know there is a reason. That's why I'm asking why they are being kept that long. They aren't being continually readmitted though. Just learned that the patient who had been there for 7 months was just released last week to a nursing home. Is this how it works if they are uninsured or don't have family? The whole thing seems so complex...

When you get to 3rd/4th year you will start to see the complexity of placement. I'm sure if you ask, they'll explain it a bit. We have case coordinators on internal medicine services who coordinate social work and nursing home/SNF/ARF placement, and the amount of work and calling they go through in order to get placement for someone is often insane. Not enough beds, issues with guardianship/insurance/etc, doesn't qualify for a SNF but needs more care than a nursing home provides, etc.

 

[DrYoda]

In most cases a placement issue. Illegal alien: can't get state aid, spend your entire ECF (extended care facility) stay in the hospital. Covered by the VA: spend most of your ECF time in the hospital trying to arrange the VA to cover your ECF stay. Even for those without a overlying issue complicating things there is always bed availability and insurance issues at the local care centers the slow down the process. And of course the older you are the more likely you are to get DVTs, ICU dementia, HCAP or any other terrible condition associated with being admitted to the hospital which will prolong your stay especially if you are an already frail geriatric patient with no reserve.

 

[caffeinemia]

You're correct: acute care hospitals are not for chronic long term care.

As for why you are observing some patients with longer stays, the reasons may be:

- they have an ongoing medical need which cannot be met at other local facilities
- they are not well enough to go home
- they are uninsured/underinsured/have a plan that no long term care facilities will take
- they are not actually there for 6+ months but keep getting readmitted
- they are in a chronic care/LTC/hospice unit of the hospital, not an acute care unit

Placement issues are the bane of any resident physician. Why don't you ask next time you're there? It can actually be a good learning experience for you to see some of the less "glamorous" side of medicine.

(BTW, residents are physicians; your title may be construed as uninformed at best, insulting at worst)

This lady is right. Except... that last part. I'm pretty sure as a surgical resident, I am somewhere above medical student and below pond scum

Also, praise the lord for case managers and social workers!