Reply #93: Cost cutting in snfs with rehabs for subacute patients [View All]

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usually results in higher readmission rates at the hospital. One if the first things they have cut is the food. We just had an elderly woman sent back to the hospital with CHF exacerbation because of the high sodium foods they gave her. She gained 12 lbs in 2 weeks. The family had requested low sodium, told them she was not supposed to give her salty foods. They also complained that they were not weighing her everyday-- btw, these items were discharge instructions ordered by the Dr. When she was in the hospital, she did not have any lower extremity edema, but she returned with it.

In Jan. Medicare will no longer compensate hospitals for patients with CHF who have been readmitted within 30 days (as well as some other diagnosis). We are working really hard on teaching positive self care behaviors to prevent this but how can we do this when the nursing home facilities don't even follow it? I feel we should send them the bill for this new hospitalization, esp. since it will likely be for 7 days, on telemetry. In fact, I had recommended to her family that at the follow-up Dr. visit (which never happened since she came back to the hospital beforehand) to ask for an order for home care and get out of the nursing home so they can control the food and get her weighed every day.

This trend in cuts is very bad and will have many unintended consequences. The reason why nursing homes should be paid much more for subacute rehab is because those patients require more services than the average long term care resident. They get 2 or more physical therapy sessions a day, full baths, are monitored much more closely by nursing, dressing changes, they have more complicated medications and are often full code status necessitating more licensed people on the floor. Nursing homes are also very highly regulated, more so than the nuclear industry. Those three week rehab stays often go home with homecare services.