As skilled nursing facilities and nursing homes face increasing pressure to avoid rehospitalizations, they can draw some lessons from a study from Yale and the Scripps Gerontology Institute that examined the impact of cross-sectoral partnerships on preventable health care spending.
Area Agencies on Aging (AAA) coordinate social services for older adults across the U.S. and regularly work to address social determinants of health. This is sometimes done in partnership with other health care organizations, such as behavioral and mental health organizations, hospitals, community health care providers and long-term care facilities.
The study, published in Health Affairs, examined whether the involvement of AAAs in cross-sector collaborations was associated with decreases in potentially avoidable health care spending and use among older adults. The researchers focused particularly on hospital readmissions among nursing home residents.
The team looked at data from the National Aging Network Survey of Area Agencies on Aging, which was administered to 613 AAAs in 2013 by the National Association of Area Agencies on Aging in partnership with the Scripps Gerontology Center at Miami University of Ohio. Researchers also used county-level data for three measures of avoidable health care use and spending in 2014.
“We were really interested to find that there does seem to be a relationship between some of the AAA programs, as well as some AAA partnerships, and potentially preventable health care use among older adults,” Amanda Brewster of the Yale School of Public Health, one of the study’s authors, told Skilled Nursing News.
Nursing home overuse
The study tracked various measures of avoidable health care use, such as all-cause risk-stratified hospital readmission rates (RSRRs), total Medicare spending per beneficiary, and the percentage of nursing home residents in a county of low-care status. Stronger care coordination services could prevent these placements by meeting in-home care needs, the study said.
The research found that counties where AAAs maintained informal partnerships with a variety of organizations, both in health care and other sectors, had significantly lower hospital readmission rates. A county with 14 or more types of informal partnerships had an RSRR decrease of 0.22 percentage point, compared with those with lower numbers of such collaborations.
This suggests an area where long-term care (LTC) facilities could shine; 69.1% of the 2013 survey respondents indicated they had informal partnerships with LTC facilities.
“Diverse informal partnerships maintained by an AAA may indicate a denser web of interconnection across organizations in the community, which could support the handoffs needed to help patients recover after hospital discharge and avoid rehospitalization,” the researchers wrote.
However, collaboration could also lead to a decline in nursing home demand: Counties whose AAAs had a program to divert consumers from nursing home placement had a 20% lower share of nursing home residents who were at “low-care status,” compared with those counties whose AAAs did not have such a program, Brewster said. Low-care status indicates residents who are relatively high-functioning and do not need extensive physical assistance.
“A number of those might be able to manage at home if they had the right kind of social support, such as transportation and in-home services,” Brewster explained.
Written by Maggie Flynn