Closing rural hospitals will result in “significantly fewer” hospitalizations for residents at nearby nursing homes. This is a sign that those residents may not have access to the care they need.
A study published in the Journal of Rural Health over the weekend said that a decrease in hospitalization could have a significant impact on residents who need care in any type of hospital, whether in an emergency or an elective situation.
Researchers from Vanderbilt University and the Cecil G. Sheps Health Services Research Center at the University of North Carolina, Chapel Hill, believed that it would prove that occupancy rates in independent nursing homes would increase after a rural hospital where swing beds or skilled nursing units were closed.
It didn't pan out, but the increase in occupancy was “consistently close to zero after closure,” but the team found hospitalizations of nursing homes jumped 13%.
Initially, the change was “moderate,” but the effect “has become more negative in the years since closure,” the researchers reported.
“One reason closures could lead to fewer hospitalizations is because of reduced access to care,” they wrote. “New distances to services may have made transportation more convenient and accessible, and reduced use of hospital services by nursing homes. While the findings cannot explain whether a decrease in hospitalization reflects a decrease in urgent, urgent, and/or selective admission, the impact on nursing home residents could be substantial.”
Brock Slabach, former hospital administrator and now the CEO of the National Rural Health Association, is well aware of the interconnected relationships between hospitals and skilled nursing facilities.
The hospital doesn't just approve patients, he said in an interview with McKnight's Long-Term Care News on Monday. They provide tertiary services ranging from laboratory work to rounding and medical directions, emergency department visits and admission if necessary.
“In rural communities, the continuum of care is vulnerable,” he said. “Increasing distance to hospitals can affect quality. Here, access is a factor in quality.”
This study is thought to be the first to look at how skilled nursing components affect the closure of rural hospitals present in local nursing homes.
Move the pain
One of the main issues raised by the study authors and Slabach is that medical transport in nursing homes becomes much more difficult when nearby acute facilities close the door. It may already take 45 minutes for the ambulance to arrive in the countryside provided by volunteers. Add an hour drive to the next closest hospital, and providers should weigh more factors before sending patients.
There are also challenging logistics and payment issues associated with longer transport, particularly when an ambulance needs to cross a patient's county or state, or when the patient is unable to pay for that long transport due to an elective procedure or fact-finding test that is not available in the nursing home.
In emergencies, such delays can “contribute to worsening health outcomes and increased mortality,” the researchers noted.
Even if the nursing home wants to check patients after a fall, long distance travel should be carefully considered. The study authors noted that these types of urgent, but not necessarily threatened cases, “the situation could worsen and potentially lead to a state of emergency.”
Telehealth could be an option to avoid monitoring some patients or unnecessary emergency room visits, but Slabach said it cannot replace the personal touch offered by nearby rural hospitals.
He said the study is something policymakers should consider when discussing ways to protect rural health access. Since 2010, approximately 151 rural hospitals have been closed.
In addition to determining that occupancy remains stable elsewhere after closure, the researchers also found that the percentage of Medicare pay residents and average ADL scores remained stable for residents of local nursing homes.
But even if federal regulators try to block them, it is expected to have a negative impact on hospitalizations — worries supporters like Slabach.
“The closure of (rural hospitals) shows that we reduce the systemic approach to healthcare we have in this country and ultimately affect patients across the system,” he said.
