A recent study reporting that 40% of nursing home-to-hospital transfers are potentially preventable sparked an outpouring of firsthand accounts from EMS professionals. From avoidable psych evals and dislodged feeding tubes, to transfers for routine procedures, readers say the problem may be even worse than the data shows.
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Many pointed to poor staffing, training and flawed reimbursement models as root causes. Here鈥檚 what 麻豆原创 readers had to say about the persistent drain on EMS resources and what鈥檚 driving these calls.
鈥淎s the Director for my agency who sees 100% of all our reports generated, I would say it is a conservative estimate that at least 85% our NH calls do not need to be transported by EMS. My agency is a small rural county agency, that has only one nursing home in its area. The residents of this NH more often rely on state aid for their medical bills. It is frustrating as an EMS provider to see this vulnerable population shipped to a hospital needlessly, because as one NH care provider puts it, 鈥渄on鈥檛 want to deal with them on my shift today.鈥�
鈥淢any of these issues are the result of lack of adequate staffing in nursing homes. This will only get worse with the cutbacks and lack of regulation due to the Big Beautiful (ugly) Bill.鈥�
鈥淎 lot of the common diagnoses mentioned are chronic, the majority of the time are issues where the resident鈥檚 PCP doesn鈥檛 want to be bothered or deal with and orders the nursing homes to just send the resident to the ED. Also, what wasn鈥檛 mentioned, were the percentage of residents where they reside in the memory care units with history of dementia and Alzheimer鈥檚, are transferred out to the ED for psych evaluations ... the biggest unfortunate thing is, they are called in as 911/emergency calls and not transfers.鈥�
鈥淚n Maryland, Medicaid won鈥檛 pay commercial ambulances to transport. They call 911 for everything 鈥� non-critical labs, X-ray results etc. Abuse of the system. These patients occupy ER beds and EMS encounters obnoxious wait times for a bed.鈥�
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鈥淎t least 50% of our nursing home runs could have been avoided with better on-site care or better planning for transportation. It鈥檚 just easier for the nursing homes to call 911. We are quicker and cost nothing.鈥�
鈥淚 am a retired RN, CEN, FF/REMT-P and have worked with county ambulance services, private large-city ambulance services, and city fire dept. fire/EMS services, transporting nursing home patients on a regular basis, during all of my 40 years of service. I also regularly cared for nursing home patients in the ER. We routinely received terminal patients from nursing homes, when the care staff on duty at those facilities noted altered mental/breathing/or abnormal vital signs. Just what these care staff were trained to expect in terminal cases remains to be seen. In a large city, I was once called to nursing home for a patient who had altered breathing. Upon entering the patient鈥檚 room, it was obvious that the patient was not breathing. A quick pulse check confirmed that the patient was deceased. Down time was uncertain, however I immediately inquired about the patient鈥檚 code status. The care staff member acted like she had no idea what that meant, and as we came to find out, this facility did not feel that information was important! In falls at the nursing home, many patients require x-rays to ensure there have been no fractures. It seems that transportation would be required in these cases. Care staff qualifications pretty much dictate when an ambulance is called. Until staff at these facilities can be brought up to speed regarding necessary transport, and expected signs/symptoms in terminal cases, we/you will continue the make the nursing home runs.鈥�
鈥淎t least once a week I encounter SNF transfers that could be avoided. Most recently from an assisted living facility that has expanded to hospice and sends out patients with conditions that can be expected at the end of life. The DON did not know that hospice nurses can replace foleys on scene. Another LTAC transfers chronic conditions like arthritis pain and dementia progression, especially on weekends, seemingly to reduce census.鈥�
鈥淢any, many calls to nursing facilities have been dispatched and reported by the staff as erroneous. Many calls the patient was much more sick than reported.鈥�
鈥淔eeding tube displacement during off hours and the ECF staffers鈥� lack of operations knowledge contribute hugely to unnecessary transports. Consider the following scenario: A pt. at the ECF has a displaced feeding tube between the hours of 1700 and 0600. ECF staff sends pt. to the ED. ED is unable to replace tube. Pt. is sent back to the ECF. ECF then calls back at 0600 to send the pt. back to the hospital for tube placement by surgeon who is now in-house. The expense of wasted transportation is absurd.鈥�
鈥淥ne of the worst decisions within the nursing home industry was the restriction of patient safety devices. Posey vest and waist restraints were removed from use, citing patient safety, which then lead to tens of thousands of patients falling with life threatening-traumatic injuries.鈥�
The conversation , with readers commenting:
鈥淚 was dispatched to a nursing home to transport a patient to the ED. When I got there, I found out the only reason the woman was being sent was to have an IV started. Not a central line or a PICC, just a normal everyday IV. I knew I should not have been shocked but I was when I confirmed it was just for a normal IV. I offered to do it rather than having the woman go through the hassle of a 5-minute transport. The doctor who happened to be there and the nurse acted like I was going to perform brain surgery. IV started, pt barely woke up and we were seen as heroes until the next time we showed up.鈥�
鈥淢any years ago, we took a patient from a nursing home to a doctor鈥檚 appointment over 2 hours away ONLY for the doctor to say, 鈥淲hy did they (the nursing home) send her all this way, I could have done this virtually鈥�! I was like really doc, my partner and I was already thinking this was a ridiculous transport!鈥�
鈥淚 love the calls that my patient never leaves the stretcher and are discharged back the nursing home all in the same hour.鈥�
鈥淒on鈥檛 blame the nursing homes鈥lame the regulations! Getting orders isn鈥檛 always the easiest when working with providers. When there is a delay, not because the facility didn鈥檛 try, they will get cited, so they call 911. Plus dealing with families in any of these circumstances leads to a complaint for a facility. So they call 911 so they can have the patient evaluated in the ED.鈥�
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