Association between economic status and discharge destination among elderly patients from acute care hospitals

Objective　The aim of this study was to investigate the association between economic status and discharge destination of elderly patients from acute care hospitals.Method　We conducted a case-control study using data from a survey of elderly discharged patients conducted under the subsidy program of the Japanese Ministry of Health, Labour and Welfare. The questionnaires were mailed to 1,068 acute care hospitals located in the Kanto and Kansai region. The survey asked medical social workers or nurses, who were responsible for the discharge planning, to answer questions about the discharge of elderly patients from their hospitals. The survey included questions about discharge destination, economic status (how much the patients could afford for their care and living per month), family members living together, primary caregivers, physical status, and dementia status for each discharged patient.Results　We analyzed the data for 565 patients from 179 hospitals, of which 293 patients were discharged to their home and 272 patients were discharged to long-term care facilities. Patients who could afford to spend less than 100,000 yen per month were six times more likely to be discharged to their homes than patients who could afford to spend 100,000 to 150,000 yen per month (OR: 6.48, 95% CI: 2.50-16.79). Patients who could afford to spend more than 150,000 yen per month were 70% less likely to be discharged to their homes than patients who could afford to spend 100,000 to 150,000 yen per month (OR: 0.29, 95% CI: 0.12-0.69). Half of the patients who could afford to spend more than 150,000 yen per month were not discharged home, and instead selected private and expensive long-term care facilities.Conclusion　We observed an association between economic status and home discharge from acute care hospitals. As the monthly expenditure capacity of the elderly patients decreased, the likelihood that they were discharged to their homes increased. This suggests that elderly patients, who are economically disadvantaged, may select discharge to their homes due to limited options for discharge destinations that fit their budget. The Japanese government should arrange more low-cost facilities and home care services for low-income elderly patients.