The conveyor belt to nursing facilities


alnorman_headshotBy Al Norman

A friend of mine recently took himself to the emergency room of a local hospital. He is a 70-year-old diabetic, and his temperature was 103 degrees. He has learned to react quickly to medical problems out of fear of his diabetes complications.

The ER sent him back home with some pills to lower his temperature, but he returned the next day with his fever still high. He was admitted to the hospital for three days, and was diagnosed as having a bone infection that could seriously threaten his foot.  His hospitalist told him he would be discharged to a rehab facility for “post-acute care.”

My friend followed medical advice. He was scared to go home. He had been told he could only get one home health nurse visit per day. This would not work, he was told, because his IV drip needed to be looked after twice a day.

My friend asked me which rehab I recommended. I told him what I thought, and then my friend and his son—who had been researching on the Internet—picked a facility.

When I went to visit my friend a couple of days later, the first thing he blurted out was: “Home care is the way to go, boy!” He told me he had to badger staff to be able to take a shower, and had missed dinner once because his physical therapy session was not over in time. He was not a happy guy—and his hospitalist had told him he might be at this facility six weeks or longer.

I asked my friend if anyone had told him about his options to go home from the hospital. He said no. I did not push the issue because he was clearly convinced that a rehab was his only option.

This scenario is not how it’s supposed to work. Under MassHealth state law, “A person seeking admission to a long-term care facility paid for by MassHealth shall receive pre-admission counseling for long-term care services, which shall include an assessment of community-based service options. A person seeking care in a long-term care facility on a private pay basis shall be offered pre-admission counseling.”

My friend never got this pre-admission counseling. I imagine that his hospitalist does not know about the right to pre-admission counseling. Perhaps no one at the hospital knows this—even though this law has been on the books for nine years.

Last year, a group called the Health Policy Commission (HPC) noted that the rate of residents in nursing facilities in Massachusetts was 46 percent greater than the U.S. average. “Massachusetts has a higher rate of discharge from hospitals to nursing facilities relative to the national average,” the HPC found, “suggesting an opportunity to manage post-acute care more efficiently…there are opportunities to deliver more supports in home-and community-based settings, expanding options for patients to receive care in their preferred setting while potentially achieving savings over time.”

There is a conveyor belt that carries people like my friend from ER room, to inpatient care, to skilled nursing facility (SNF). It goes one way. The law requiring pre-admission counseling is not being fully implemented. Hospitals in Massachusetts discharge patients into SNFs at a rate 8 percent higher than the U.S. average.

People need to be told their options—so they can get not only the kind of care they want—but where they want it. At home.

Al Norman is the Executive Director of Mass Home Care. He can be reached at 978-502-3794, or at Archives of articles from previous issues can be read at