September 23, 2011
Seniors who are released from the hospital too soon can encounter problems that are costly for their health as well as the Medicare system. That’s why it’s important to ensure that an elderly loved one has the appropriate follow-up care as well as help at home to heal and recover.
Q. My 85-year-old mom was sent back to the hospital after being discharged home soon after recovering from a serious illness. Is this common and what can be done about it?
It’s more common than you know. A 2009 study found that one in five Medicare beneficiaries discharged from the hospital was readmitted within 30 days. An additional 34 percent of those 11.9 million Medicare beneficiaries were rehospitalized within 90 days. What’s more, half of non-surgical patients who were readmitted to the hospital within 30 days had not seen an outpatient doctor in follow-up.
In another breakdown of the numbers, 67.1 percent of patients who had been discharged with medical conditions and 51.5 percent of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge.
It’s a serious issue in terms of health and money. Those statistics have added up to a whopping $17.4 billion for Medicare, the study says. The study by Stephen Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H., highlights the costs and health impact of rehospitalization. It also details the key reasons for rehospitalizations, and highlights gaps in patient management that may be contributing to the high rates.
Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5 percent were rehospitalized for a medical condition. The study estimates that only about 10 percent of rehospitalizations were likely to have been planned. The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously.
The study also showed that a history of rehospitalization and prolonged length of hospital stay were stronger predictors of rehospitalization than age, gender, race, poverty or disability. The authors suggest several steps to reduce rehospitalizations including:
- interventions to better educate patients about self-care in the hospital discharge process;
- helping hospitals better understand their comparative performance on readmissions by providing them readmission data for their patients including those who were rehospitalized elsewhere;
- collaboration between physicians and hospitals to ensure patients get follow-up care; and
- follow-up care from a primary care doctor as well as a surgeon for surgery patients.
It’s also may be important that a senior recovering has the help he or she needs. That’s why at-home non-medical assistance also could be of benefit. Local Home Instead CAREGiversSM often handle tasks around the house such as meal preparation, light housekeeping and medication reminders, which can help seniors devote their energy to recovering.
For more about the study, visit http://www.nejm.org/doi/full/10.1056/NEJMsa0803563.
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