Waiting for beds. (discharging hospital patients to nursing homes) (column)

If quicker's sicker, is longer stronger? The former rhyme has been used to castigate the Reagan administration and the HCFA (Health Care Financing Administration) for policies favoring early discharge of elderly hospital patients. "Quicker and sicker" reportedly inundated nursing homes with patients in worse shape than under previous, more relaxed scheduling.

Now, however, an increasing number of states are reporting delays in discharging hospital patients to nursing homes, because there aren't enough nursing home beds to receive them.

That is more of a problem to hospitals than to nursing homes. Under the administration's DRGs (Diagnostic Related Groups) system, hospitals receive set amounts for patient treatment, according to its nature. If they hold patients longer than the payment plan allows, that's the hospitals' problem. They may be able to obtain Medicaid/ Medicare reimbursement, but that may cover only one-quarter of the daily cost per bed.

The patients in the holding pattern, of course, have problems, too. Not only are they denied the proper care that a nursing home would provide, but they also are exposed to further medical difficulties.

Official bureaucratese for that situation is "administrative necessary days"- days when elderly patients ready for discharge have to stay in the hospital until a nursing home can take them. The label "hospitalto-nursing-home delays," used by a research institute that will remain nameless, may be more of a mouthful (if more descriptive). "Hospital backups" is a term that this column will adopt.

The severity of the problem varies state by state, region by region. States that have more tightly-capped nursing home expansion are more afflicted. Massachusetts and Maine are reportedly backed up. New York State may be. Some states and regions that have better-developed systems of home-health care or sufficient hospital swing beds may not have much backup.

While hospitals are more vitally affected economically, the issue is strategically significant to nursing homes. The extent of backups may indicate whether there are sufficient nursing home beds. Some statistics could furnish a potent argument why states should liberalize on nursing home expansion. A political strategist certainly would like to have that number if working in government relations for a long-termcare chain or nursing home association.