1 June 2010CHOOSING NURSING HOME FOR OLDER PEOPLE: DRG SYSTEM AND MORE
Ideally you will have the luxury of making a fully informed choice. In reality your options are likely to be more limited. If your relative is arriving from the community, the best homes tend to have long waiting lists. Priority is given to patients coming from hospitals. Even if your ideal choice has a wait years long, get on the list. Beds do open up.
If your relative is in the hospital, you may not have time to choose at all. Hospitals used to be paid by the day. According to a new reimbursement method called the DRG system, the hospital is now paid a fixed sum before admission according to the person’s “diagnostic related group” -the cost of an estimated “average length of stay” for that condition. This system was devised as an incentive to discourage unnecessarily long hospitalizations. Instead of benefiting economically by keeping patients longer, hospitals now benefit by discharging them sooner, because they collect the same fee regardless of how many days a person stays.
Critics of this system argue that it discriminates against the elderly because, being more frail, they tend to require more time than “average” to recuperate from illness or surgery. Apart from whether this argument has merit, the practical effect of the DRG system is this bottom line: your relative will be pressured to leave the hospital as soon as possible, pushed to accept the first available bed in any area nursing home. But you can forestall this by knowing in advance which homes are acceptable and telling the hospital social worker to call only them. So start your inquiries the minute you think institutional care may be needed -for instance, when your relative enters the hospital.
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GENERAL HEALTH
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