Preparing for a better outcome at home

According to the Centers for Disease Control and Prevention (CDC), every year, more than 20 million adult patients are discharged from U.S. hospitals. And on average, for every five Medicare patients discharged from a hospital, at least one will return within a month, and one in three will be back within 90 days.

The good news is hospitals and other health-care facilities are using new and innovative techniques to reduce readmission rates. Seniors, who make up the largest portion of readmissions, are a special group, and what works for most people may not work for them.

Usually, when someone is discharged from a hospital, families are expected to provide care and take on the dayto-day responsibilities until they are able to care for themselves. Parents help children rehabilitate, spouses help partners shower, dress, provide medication reminders and get them to follow-up doctor’s appointments.

Older people are less likely to have that strong family support. Adult children have their own busy lives and may not even live in the same town. Spouses, although well-intentioned, are frequently unable to properly care for their loved one due to lack of physical strength or impairment. Compounding all this, seniors may be depressed because they are in a weakened, vulnerable state.

For a better outcome, seniors need a constant advocate – someone to walk them through the discharge process, help them get home, fill any new prescriptions and make sure there is food to eat. They also may need assistance with organization and understanding of discharge instructions including medication management and side effects and reminders of scheduled follow-up doctor’s appointments.

The four primary causes of hospital readmission are 1) poor medication management 2) missed follow-up appointments 3) falls and 4) lack of education about care of chronic illnesses.

Half of elderly people who take medicine four times a day don’t take it as prescribed, according to Pharmacy Times. A stay in a facility can complicate things further as patients often go home with new prescriptions and instructions. If they have forgotten to mention a current medicine or supplement to the doctor, interactions may occur. Clear instructions, a medication reconciliation and a method of accountability contribute to a successful recuperation.

Patients miss follow-up appointments for various reasons. They forget, they don’t have transportation or they don’t know which doctor with whom they should follow-up. Upon discharge, creating an appointment calendar which specifies the physician’s name, specialty and time of appointment helps to ensure no missed appointments.

According to the CDC, one in three people 65 and older fall each year landing them in the hospital – often with the need for emergency surgery for a broken hip. Having a plan in place for proper exercise, regular eye exams and a home safety evaluation can reduce falls and hospital readmission.

The CDC reports about 80 percent of older adults have a chronic illness, and half have at least two. Yet many don’t fully understand their symptoms and what to do when they have a problem. Instead of calling a health-care provider, they often go straight to the emergency room for problems that are not emergencies. During the discharge process, discussing chronic illnesses and how they apply to the recuperation process is critical for positive outcomes.

Post-acute services consist of a short stay in a rehabilitation center, skilled nursing facility or receiving in-home care. Sadly, according to one study, 28 percent of patients refuse post-acute services and are twice as likely to return to the hospital within 60 days. Those who accepted post-discharge home care reported better quality of life and fewer readmissions.

Skilled home health agencies are licensed and regulated by the Louisiana Department of Health. Their services must be provided under the order of a physician in the place of residence of the person receiving care in order to be covered by Medicare or other health insurance. Care includes skilled nursing and at least one of the following services: physical therapy, speech therapy, occupational therapy, medical social services or home health aide services.

Most post-surgery and hospital patients will also require some form of “hands-on” care when they return home. Care needs may include assistance with bathing, dressing, toileting, grooming, transferring, ambulation and eating. These services can only be provided by a home care agency licensed and regulated by the Louisiana Department of Health. Since a physician’s order is not required for this type of care, neither Medicare nor private health insurance will pay for these services.

A sitting service cannot provide “hands-on” care. They are not regulated or required to be licensed. According to Louisiana law, they may only spend time with an individual, accompany on trips and outings, prepare and deliver meals as well as provide housekeeping services.

If home care is needed following an elective surgery, planning ahead and having in-home care arranged in advance will result in a smoother facility to home transition and better outcomes. Although care needs may change postsurgery or after a hospital discharge, a good, reputable home care company will have the experience and flexibility to meet any and all of your care needs.

Scott H. Green is a Certified Senior Advisor ® and president of Preferred Care at Home of Northwest Louisiana. Green can be reached via e-mail at scottg@preferhome.com.