I second the suggestion of Health Care Financing Administration Administrator Nancy-Ann DeParle that some of the patients being refused admission by nursing homes may really belong in acute-care hospitals ["Nursing Homes Shun Some Medicare Patients," front page, June 7]. I question whether a patient on a ventilator, for example, is appropriately placed in a nursing home. Nursing homes typically have a devoted but minimally trained nursing staff, consisting mostly of nurses' aides, with a sprinkling of licensed practical nurses and a few registered nurses providing supervision, who (like myself) may have superannuated technical knowledge and skills. Often no registered nurse is assigned to a given floor on an evening or night tour.

Although many technical nursing skills are relatively simple to perform, a knowledge of their desired and undesired physiological effects as well as of the effect of a variation in the technique reduces the risk to patients. For example, giving a tube feeding is simple, but if the tube is displaced and the feeding goes into the patient's lungs, it is disastrous.

My guess is that many of the patients referred to in the news story may need to be in an acute hospital. Perhaps the financially driven discharge practices of acute hospitals need more attention.


Sandy Spring, Md.