Background Nursing home admission policies are one driver of increased and earlier gastrostomy placement, a procedure that is not always medically or ethically indicated among patients needing short-term nutrition support. This important clinical decision should be based upon patient prognosis, goals, and needs. We compared nursing home enteral nutrition-related admission policies in New York City and other regions of the United States. We also explored motivations for these policies. Methods We conducted a telephone survey with skilled nursing facility administrators in New York City and a random sample of facilities throughout the United States about enteral nutrition-related admission policies. Survey data were matched with publically available Centers for Medicare and Medicaid Services facility characteristics data. The relationship between facility location and admission policies was described with regression models. Reasons for these policies were thematically analyzed. Results New York City nursing homes were significantly less likely to admit patients with nasogastric feeding tubes than nursing homes nationwide, controlling for facility characteristics (OR=0.111, 95% CI=0.032, 0.344). Reasons for refusing nasogastric tubes fell into five categories: Safety, capacity, policy, perception of appropriate level of care, and patient quality of life. Conclusion Our findings indicate that enteral nutrition-related admission policies vary greatly between nursing homes in New York City and nationwide. Many administrators cited safety and policy as factors guiding their institutional policies and practices, despite a lack of evidence. This gap in research, practice, and policy has implications for quality and cost of care, length of hospital stay, and patient morbidity and mortality.

No abstract