The Cost of Medically Unnecessary Days Due to Waiting for Guardianship in a State Acute Hospital System.

Hospitals must do more with less, making efficiency a priority. Discharge delays create challenges for acute care hospitals. Some delays are due to patients waiting for a guardian-a person appointed to assist an adult who lacks decision-making capacity. Previous studies examine the burden of excess days in a single academic medical center (AMC); however, these institutions do not represent the entire hospital system. This descriptive study expands upon previous analyses by calculating the financial implications of medically unnecessary days in a state's hospitals to payers. Two models are presented: one calculates the gross patient service revenues required to support excess days; the other calculates the expense to hospitals. Results suggest that substantial funds are required to support excess days. Funds may be better allocated to support the health and well-being of people needing medical care or to address the cause of delays due to waiting for guardianship.

Special Need Pooled Trust Disbursements and the Well-being of Nursing Facility Residents Receiving Medicaid Benefits.

Medicaid is the largest health insurer in America, comprising one-sixth of the nation's total healthcare expenditures. Of this, 40% covers long-term care services for older adults and adults with disabilities. Yet, Medicaid does not provide access to all goods and services needed. Pooled special needs trusts (pooled trusts) are a program through which older individuals, requiring long-term care, may set aside assets and remain Medicaid eligible. Pooled trust funds purchase items such as medical devices, telecommunications and funeral services. This article explores the relationship between Medicaid, pooled trusts and their role in nursing home residents' well-being. To understand this relationship, a descriptive study sorts the disbursements from a pooled trust into the 5 Gallup-Healthways Index well-being domains. The analysis shows that pooled trust funds purchased goods and services related to well-being. Thus, pooled trusts offer a means for states to expand the support they provide individuals in nursing facilities beyond the medical services covered by Medicaid to include goods and services associated with well-being.