The issue of when to transfer nursing home residents to a hospital requires several considerations. In some nursing homes, physicians, nurse practitioners, or physician assistants are present for several hours every day, and a highly skilled nursing staff is available to manage IV lines, suctioning equipment, and sometimes ventilators. In other nursing homes, physician visits are sporadic, and few experienced nurses are on staff; therefore, a patient may need to be transferred to a hospital for technical or highly skilled care.
Nursing home staff often try to avoid hospitalizing patients, because all too often patients return from a hospitalization with urinary cathe¬ters and pressure sores. Patients are often confused, severely decondi-tioned, and receiving psychoactive medications. Many families and res¬idents also prefer to avoid hospitalization not only for these reasons but because treatment in hospitals can be dehumanizing and impersonal.
When transfer to a hospital does occur, medical records should ac¬company the patient. A phone call from a nursing home nurse to a hos¬pital nurse is useful to explain the patient’s diagnosis and reason for transfer, the patient’s baseline functional and mental status, the pa¬tient’s medications, and care directives as expressed in a living will