The District improperly spent $16.7 million in city and federal dollars last year to provide over 1,700 persons with moer intensive hospital care than they needed, the D.C. Municipal Research Bureau said in a report released today.
Patients who should be in less expensive, long-term care facilities, of which the city has a shortage, are confined to acute care, psychiatric and chronic rehabilitation hospitals, the independent research group said in its report.
Consequently, during fiscal year 1976 it cost $9.5 million at federally funded St. Elizabeths Mental Hospital, and $7.1 million at city hospitals, including D.C. General, for this excessive patient care, the study found.
The problem is that Washington has too many acute care beds, about 7.5 per 1,000 persons compared to the national average of 4.9 beds; and too few long term care beds, about 40 per 1,000 elderly while the national average is about 52 beds.
Many of the independant Research group's findings were based on previously published material on this long recognized problem. The report adds, however, a series of fresh conclusions and recommendations for correcting the imbalance.
The report noted as one factor in the problem that not all of the District's 2,208 lincensed nursing home beds are in use. Of these, only 1,463, as of last June, are in institutions that are willing or certified to receive Medicaid and Medicare patients.
Among the unused beds, more than 200 are at D.C. Village, where the capacity of 712 patients is being reduced to 400 to comply with federal staff-to-patients ratios for continued Medicaid funding, the study noted.
Patients needing these unavailable nursing home beds end up at D.C. General and other acute care hospitals costing over $200 per patient day. The costs range from $52 to $82 at D.C. Village and from $26 to $33 in private nursing homes, depending on the level of care, researchers found.
The research group recommended solutions including:
Conversion of the 560 acute care hospital beds that city planners have said are unneeded to nursing care beds. As many 150 such beds could be converted at D.C. General for $650,000 or less, the study said.
Request for a waiver from the Social Security Administration, which administers Medicare, so that caute care beds could be used temporarily for long term care, a solution used in some rural areas.
Purchase of the Metropolitan Hotel, a former nursing home facility, which could provide 531 long term care beds at $16,700 each, compared to one developer's estimate of $33,000 per bed to build new facilities.
Renovations of the 256-bed J.B. Johnson nursing home, completed in 1972, but never used because it has safety code deficiencies.
In any case, the researchers noted, the District should assess the availability and need for nursing home beds. The city's Office on Aging, required by federal regulations to conduct such a study, has been in operation for two years without doing so, the report said. It estimated that such an analysis would cost $120,000.