Going to the hospital brings with it a number of iatrogenic risks for geriatric patients, says Ouslander, who is also professor and associate dean for geriatric programs at Boca Raton, Fla.-based Florida Atlantic University’s medical college. These include disorientation, acute confusion, or delirium; hospital-acquired infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, which causes diarrhea and other intestinal disease; complications from catheter placement; falls; skin breakdown; disruption of care; adverse effects of drugs; and the consequences of being immobilized in bed, including pressure ulcers and deep vein thrombosis.

Further, residents suffer from what’s known as “transfer trauma”—which often causes psychological harm and mental and physical deterioration and can even result in death, according to studies.

“It’s at best a very disorienting experience” for nursing facility residents, says Reitz. “I speak to that first hand, having had a mother who had to go back to the hospital. I was with her and watched the process, and it’s not that providers in acute care are bad, but they’ve got a lot of stuff going on.” Because the resident has had the benefit of facility clinical staff being as on top of the situation as possible, “folks coming back from our setting are lower in the queue,” he says.

A recent study showed that treating residents with pneumonia or lower respiratory tract infections using a clinical pathway in the nursing facility can benefit residents both in terms of the outcome and the transfer trauma avoided.

However, the study also found that nursing facilities would need to receive supplemental funding that could be used to hire a nurse practitioner.
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