A Community-wide Program to Improve the Efficiency of Care Between Nursing Homes and Hospitals

Ronald J. Lagoe, PhD; Janet Dauley-Altwarg, JD, MHA; Saundra E. Mnich, MSN, RN-C; Lynn M. Winks, RN, AAS


Topics in Advanced Practice Nursing eJournal. 2005;5(2) 

In This Article

Population and Healthcare System

This study describes the implementation of a cooperative program between hospitals and nursing homes in the metropolitan area of Syracuse. This area includes the City of Syracuse and Onondaga County. In 2002, this area had a total population of 455,548, where 13.9% were 65 years or older and 4.1% were 80 years old or over.

The metropolitan area of Syracuse includes 12 skilled nursing facilities that maintain 2929 beds, or 46.8 beds per 1000 populated aged 65 years and over. Sixty percent of these beds are located in 4 large facilities: Loretto, St. Camillus Health and Rehabilitation Center, James Square Health and Rehabilitation Center, and Van Duyn Home and Hospital. The area has 4 general hospitals, including 1661 inpatient beds and 1140 medical-surgical beds. In 2003, the hospitals generated 70,814 inpatient discharges. They include Community General Hospital (10,378 discharges), Crouse Hospital (20,488 discharges), St. Joseph's Hospital Health Center (23,962 discharges), and Hospital of the State University of New York Upstate Medical University (15,986).

Onondaga County has a history of cooperation between long-term care facilities and acute care providers toward a shared goal of improving the outcomes and efficiency of care in the community. These programs focused on enhancement of long-term care services that would support the continued movement of persons through the healthcare system. These efforts involved the addition of a temporary nursing facility capacity to some providers.

The first of these efforts, implemented in 1987 and 1988, was a demonstration program to focus admissions to nursing facilities on nonacute patients who remained in acute hospitals for extended periods of time. The project involved the development of 50- 70 temporary nursing home beds in the system and prioritization of hospital patients admitted to these beds. The program provided limited relief from hospital overcrowding.[13,14]

The second program also involved the addition of temporary nursing home beds to the Syracuse healthcare system for brief periods of peak hospital overcrowding. Authorization for 30 of these beds was provided by the New York State Department of Health. The program was implemented in 1999 and was used most frequently during the respiratory disease season in the first quarter of each year. Like its predecessor, the temporary beds provided limited relief for hospital overcrowding.


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