Reducing Unnecessary Hospitalizations of NH Residents

by Timothy Gieseke, MD, CMD

One of the blessings of being a Senior Clinician and long standing Medical Director of SNFs has been the luxury of having more time for exploring resources that may improve care in my facilities while spending less time on the direct patient care.  As a member of AMDA, The Society for Post-Acute and Long Term Care, I look forward to the free monthly webinars (  In August, the webinar was a very practical one on the Utilization of Civil Monetary Penalties to improve the quality of life of residents in LTC facilities.  In California, we have experienced the use of these funds through the Partnership to Improve Dementia Care in California and the Music and Memory Implementation program (attend CALTCM Fall CME program for the latest on this innovation).

One of the unexpected joys of this webinar was the offering of 2 very practical innovations in enough detail to see the potential value in facilities in our state.  The one I’m highlighting today is the one from Florida Atlantic University by Dr. Ruth Tappen as lead investigator. This study was done to see if unnecessary hospital readmissions due to patient and family preferences could be reduced by developing educational materials for use in facilities that empowers families to make more informed person-directed decisions in potential future emergencies.  The literature suggests that up to 20% of potentially preventable hospitalizations from nursing homes are due to resident and family requests. Their intervention was to develop a 14-page decision guide, a condensed Trifold version, and an audio version These tools were developed and tested across the states in Region 4 and are now available without charge on their web page at:   I have reviewed this site and found it very easy to navigate with a brief video from Dr. Tappen about the project.  In addition, they have provided a helpful implementation guide and checklist for facilities wanting to adapt this program in their facilities.  The decision guide is available in English, Spanish, Chinese, Filipino, French, and Creole. This is your tax dollars at work and worth your perusal.  

As we look to 2019, the pressure on facilities to reduce unnecessary readmissions is becoming more intense.  This may be a win-win intervention for your facilities.