title: Testing the bed-blocking hypothesis: does nursing and care home supply reduce delayed hospital discharges?
abstract: Hospital bed-blocking occurs when hospital patients are ready to be discharged to a nursing home, but no place is available, so that hospital care acts as a more costly substitute for long-term care. We investigate the extent to which greater supply of nursing home beds or lower prices can reduce hospital bed-blocking using a new Local Authority (LA) level administrative data from England on hospital delayed discharges in 2009-2013. The results suggest that delayed discharges respond to the availability of care home beds, but the effect is modest: an increase in care home beds by 10% (250 additional beds per LA) would reduce social care delayed discharges by about 6-9%. We also find strong evidence of spillover effects across LAs: more care home beds or fewer patients aged over 65 years in nearby LAs are associated with fewer delayed discharges.
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: James
authors.initials: J
authors.lastname: Gaughan
authors.forename: Hugh
authors.initials: H
authors.lastname: Gravelle
authors.forename: Luigi
authors.initials: L
authors.lastname: Siciliani
mesh_terms: D000368:Aged; D004739:England / Q000453:epidemiology; D006701:Home Nursing / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D017059:Models, Econometric; D008962:Models, Theoretical; D009735:Nursing Homes / Q000706:statistics & numerical data* / Q000600:supply & distribution; D010351:Patient Discharge / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists
keywords: bed blocking; delayed discharges; long-term care; nursing and care homes; substitution