One Leading Factor in Hospital Readmission

Now and again you meet someone who is enmeshed in their field...and loves it.  Carol Marak has a passion for educating individuals about senior living issues.  She writes regularly for multiple sources; and we have the good fortune of presenting her as a guest blogger today on AudibleRx.


One Leading Factor in Hospital Readmission

Reducing the revolving door syndrome at hospitals is on the radar of every health care system, physician's office, home health company, skilled nursing and assisted living facility nationwide.

Or is it?

It's so bad that one in every five older patients land back in the hospital within 30 days of discharge.

Most trips back are unplanned.

And most are preventable.

Here's one reason why some patients go back: They return to a lifestyle and an environment that got them there in the first place. They're left to their own unhealthy devices.

I know one patient in particular.

He's overweight. Doctors call him obese. He eats foods with lots of preservatives. He never exercises. He rarely moves, for that matter. And he's 75 years of age.

He landed in the hospital because of a bad case of cellulitis. That's just for starters. He has lung cancer, and kidney cancer - in both kidneys. And he’s addicted to pain killers due to former back problems (a story for another time).

Once discharged, he went home and began his unhealthy routine all over again... motionless, which is the worst case scenario for cellulitis.

Was he unable to follow instructions? No. He could have but chose not to.

It's not the hospitals fault.

Since the startup of the Affordable Care Act, Medicare penalizes hospitals financially on 30-day readmissions for some health conditions. Cellulitis may not be on that list of conditions, but a patient not following discharge orders is one of the reasons for a return.

The idea behind the Affordable Care Act and penalizing hospitals is to encourage them to increase the quality of care. I’m sure he received very good care. He’s still alive.

Yet, no one can teach another to take better care, if one’s not motivated to. So, maybe this particular patient is a lost cause. And how many people do you know like this?

For me one is too many.

And hospitals and discharge planners can only do so much for what seems a lost cause.

For patients that get discharged from a hospital and go directly home, one must be educated for medication adherence, post-discharge instructions, given timely follow-up visits, and receive better communication. 

Here’s Dr. Steve Leuck’s, Pharmacist and Medication Education Expert, recommendation on Hospital Readmission Rates & Care Costs can be reduced with Education. (http://www.assistedlivingfacilities.org/resources/medication-management-and-adherance-education/#proper)

Using the example of the patient described earlier, here’s how his discharge went:

No follow-up care – a follow-up visit to the physician’s office was made over a week later. (No nurse ever called to check in, even as a courtesy call).

Discharge instructions were given, but only a few were followed.

There were problems with medications, the anti-biotic dosage was too low, that was discovered a week later by the attending physician (which almost sent him back to the hospital).

The lack of timely follow-up appointments, if the patient had an earlier appointment, medication (low-dosage) could have been spotted and remedied earlier. But instead, he lived with a lot of pain (since the antibiotics weren’t working properly).

It’s a known fact that many people leave the hospital confused about their medications and lack proper understanding about their illness and treatment plan.

Maybe in this patient’s case, there’s little hope. I don’t know. I’d like to think that if he’s taken off the pain meds and learn to manage the back pain, there might be hope for him. But as it stands today, there’s little hope… at least in his heart.

Carol Marak is a contributor for the senior living and health care market. Carol writes on tough topics that older adults and family caregivers face. Her work is found on AssistedLivingFacilities.org (http://www.assistedlivingfacilities.org/) and YourSeniorOptions.com (http://yoursenioroptions.com/). Contact Carol at Carebuzz@gmail.com.

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