Residents of private nursing homes use hospital care more

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Residents of private retirement (or assisted living) homes have significantly higher rates of inpatient health service use, compared to patients receiving home care or living in long-term care homes ( or nursing), according to new data.

In a population-based Ontario study, rates per 1,000 person-months of emergency department visits, hospital admissions, alternate level of care days (i.e., less than full intensity of hospital care) and specialist physician visits increased for nursing home residents compared to long-term care home residents. On the other hand, residents of nursing homes had about 92 fewer primary care visits per 1,000 person-months, compared to residents of long-term care homes.

“Our findings may help inform policy debates about the need for more coordinated primary health care and support in private group care homes,” the authors write.

The study has been published online May 30 in the Journal of the Canadian Medical Association.

Continuum of care

Ontario’s seniors’ facility continuum includes publicly funded home care for adults living independently and shared-cost nursing home long-term care. 24 hours a day. Retirement homes, which offer communal living with meals, social activities and some support services, fall between the two. These nursing homes are mostly privately funded and operated for profit.


Dr. Derek Manis

Residents of these private facilities are an untapped population for research, said study author Derek R. Manis, PhD, a health policy researcher at McMaster University in Hamilton, Ont. Medscape Medical News.

He and his colleagues looked at 2018 Ontario health administrative data to analyze the health of residents of retirement homes, an older population that Manis considers understudied. For the results, they focused on rates of emergency department visits, hospital admissions, alternate level of care days, primary care visits and specialist physician visits.

The retrospective cohort study identified 54,733 residents of 757 Ontario retirement homes (mean age, 86.7 years; 69.0% female) by matching people’s postal codes in the health care database to those in approved retirement homes. Investigators also identified 2,354,385 residents in other settings.

Provincial health care data revealed that, compared to residents of long-term care homes, those identified as living in retirement homes had higher rates of use per 1,000 person-months of the following:

  • Emergency room visits: 10.62 versus 4.48 (adjusted relative rate [aRR], 2.61; 95% CI, 2.55 – 2.67)

  • Hospital admissions: 5.42 versus 2.08 (aRR, 2.77; 95% CI, 2.71, 2.82)

  • Alternate level of care days: 6.01 versus 2.96 (aRR, 1.51; 95% CI, 1.48, 1.54)

  • Specialist visits: 6.27 versus 3.21 (aRR, 1.64; 95% CI, 1.61, 1.68).

In contrast, the rate of primary care visits was significantly lower among participants living in nursing homes (16.71 vs 108.47; aRR, 0.13; 95% CI, 0.13, 0.14) .

Health care utilization rates were also significantly higher for nursing home residents than for home care recipients, but the relative differences were generally not as large as between nursing home residents. and residents of long-term care homes.

A “large population”

Lack of regular access to primary care physicians may be the driving factor in these outcomes, the researchers say.

The findings of his analysis were interesting, Manis said. “The real take-home message when we look at the characteristics of this population is that they are older, and there is descriptive evidence that they have a clinical profile similar to those in long-term care homes,” he said. he told Medscape. On the other hand, the latter have high rates of use of primary care. “Policymakers need to do more to ensure older people in these private facilities get the primary care they need to keep them from going to hospital.”

What would better planning look like? Manis said that in a model such as long-term care, these private facilities could have multiple physicians under contract to provide a set number of on-site visits per month. “Increasing access inside the home itself would be an important first step,” he said.

“Assisted living in most US states and Canada is outpacing the growth of nursing homes,” he added. “This is a very large population, and policymakers and scientists need to pay attention to it.” Policies must ensure proper primary and preventive care to avoid high rates of emergency care and hospitalization, he added.

“Timely and excellent paper”

Commenting on the study of Medscape Medical News, Paula Carder, PhD, a professor in the School of Public Health at Oregon Health and Science University and Portland State University in Portland, called it “a timely and excellent document that fills an important gap in our knowledge of the elderly population living in nursing homes.” She did not participate in the study.



Dr. Paula Cardier

According to Carder, the finding regarding hospital utilization points to the lack of a formal support system, leading to increased hospitalizations among residents of nursing homes, compared to residents of licensed care facilities. “This information can now be used by health systems, housing operators and policy makers.”



Dr Emmanuelle Belanger

Emmanuelle Belanger, PhD, an assistant professor at Brown University School of Public Health in Providence, Rhode Island, who was also not involved in the Canadian study, agreed that the analysis makes an important contribution to understanding this elderly population. But in terms of comparing it to the American context, she said, “it’s hard to draw a clear parallel beyond the fact that these are private long-term care settings that deserve more research to ensure residents’ care needs are met.”

The authors called for research to further examine why this distinct population visits emergency departments or is admitted to hospital.

The study was funded by the Schlegel Chair in Clinical Epidemiology of Aging at McMaster University (the Schlegel family owns Schlegel Villages, a chain of long-term care homes and retirement homes), the Institute of Juravinski Research and the Ontario Ministry of Health Research Fund. . Manis, Carder and Bélanger did not disclose any relevant financial relationship.

CMAJ. Published online May 30, 2022. Full Text

Diana Swift is a Toronto-based medical journalist. She can be reached at dianaswift@rogers.com.

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