Researchers: Netta Bentur¹, Pinhas Berkman², Irit Laxer²

Background: The transfer of older residents from long-term nursing-care institutions (LNCI) to general hospitals is costly and often unnecessary, and efforts are under way to curb the practice.

Objectives: To examine the extent and causes of transferring residents from institution to hospital.

Method: The data were drawn from the Computerized Geriatric Division for all residents in the 234 LNCIs that benefit from MoH financial LNCI (a code). To substantiate the findings, in-depth interviews were held with LNCI directors.

Findings: The annual average of transfers from LNCI to hospital, was 0.42 (SD=0.26), and ranged from 0 to 1.69 – i.e., one transfer per year for every 2.38 LNCI beds. The annual average of transfers from LNCIs licensed to provide intravenous (IV) infusions was 0.390 vs. 0.439 for unlicensed LNCIs. The potential savings from expanding the use of IV infusions to all LNCIs is some 1,000 transfers per year. The average annual transfers, from LNCIs with an geriatric department was lower than that of LNCIs without such a department (0.267 vs. 0.435 respectively, significant).

Conclusions, recommendations and policy implications: It is both feasible and important to curb the transfer of elderly patients in acute condition from LNCIs to general hospitals. The presence of a physician at an LNCI for more hours throughout the day, increases the capability of providing critical care onsite and curbing transfers. Consequently, steps should be taken, including compensation, to expand the number of hours that a physician is present at LNCIs. Steps should be taken to encourage LNCIs to provide IV in acute situations. These activities would improve the quality of care of elderly LNCI patients, reduce unnecessary suffering, and decrease medical expenditure.

Research end date: 11/2017