Do subsidized nursing homes and home care teams reduce hospital bed-blocking?

According to the World Health Organization, excessive length of hospital stay is one of the leading sources of inefficiency in healthcare. One possible cause of excessive length of hospital stay is the lack of alternative care arrangements following a hospitalization. When a patient is medically fit to be discharged and yet requires some form of support outside the hospital (a short stay at a nursing home facility or home help), which is not readily available, the patient cannot be safely discharged. The patient stays at the hospital for a longer period until a safe discharge is possible taking a hospital bed from another patient–a phenomenon called bed-blocking.

This paper investigates whether the entry of subsidized nursing homes (NH) and teams providing home care (HC) reduces hospital bed-blocking. The study takes advantage of the staggered implementation of the National Network of Long-Term Integrated Care throughout Portugal, which started in 2006. NH and HC teams belonging to this Network are publicly subsidized and operate in coordination with hospitals to ease patients’ transition out of the hospital.

The paper has three main findings. First, while the entry of both NH and HC teams in a region reduces bed-blocking, reductions in bed-blocking upon NH entry occur only for patients with high care needs.

Second, reductions in bed-blocking do not harm patients’ health: despite shorter hospital stays, treatment intensity and the probability of a readmission remain unchanged. Third, the beds freed up by reducing bed-blocking do not remain unoccupied: there is an increase in the number of planned admissions following the entry of HC teams.

Hospital care is more expensive than care provided in a NH or by a HC team. Annual savings for the National Health Service were estimated at €849 per bed-blocker. This conservative estimate of the total economic benefit of reducing bed-blocking, ignores for example the potential health benefits of reducing bed-blocking (i.e. prevented mobility losses, improved mental health).

Click here to go to the paper by Ana Moura.