“I broke our only promise,” swelling with guilt, Sarah wept as she stumbled out of the front door. Two years ago, her father asked her to never leave him in a nursing home. They pinky promised.
But how could anyone have predicted what would follow in the upcoming years? His dementia progressively worsened, complicated by falls every three months. Despite balancing his growing needs while also providing for her family, there was not much she could do when he woke up slurring his words and could not move the entire right side of his body. She ran out of options.
Sarah and her father’s broken promise is not alone. It joins a growing graveyard of wishes focused on avoiding a nursing home at all costs. And I wish I could say it is misplaced. But it’s not. 39.5 percent of patients admitted to a nursing home after a hospital hospitalization never go home. 26.1 percent pass away within one year.
As the President of Create Circles, a non-profit centered around reducing loneliness in nursing homes, I have spent thousands of hours speaking to these patients and their families. When reflecting on the series of events that occurred prior to admission, families often mention neurological conditions that quickly changed, leaving them scared and unprepared.
These experiences are consistent with countless studies. Research shows that stroke and dementia are the main chronic medical conditions associated with NH admission. The growing prevalence of these conditions and their subsequent skilled nursing facility admissions highlights the need to shift how we approach neurological care and follow-up. Just as patients after a stroke receive comprehensive physical, occupational, and speech therapy, we need aggressive care plans that prevent skilled nursing facility (SNF) admissions.
Neurological research has categorized the trajectory of illness into one of four categories: 1) short period of decline, 2) entry/reentry, 3) prolonged dwindling, and 4) sudden neurologic impairment. Based on the neurological condition, neurologists should engage patients in early conversations about disease course, resources, complications, prognosis, and recommendations to avoid SNF admissions. Involving case management to ensure proper coordination and follow-up has been shown to significantly decrease admissions to nursing homes.
While the role of SNFs will never disappear, it is important for us to acknowledge that many SNF admissions may have been avoidable. With neurologists leading early care plans and case management guiding the execution, we can help our older adults avoid a place where very few people choose to be.
Harsh Moolani is a medical student.
