More than 35 million people are discharged from hospitals in the U.S. each year after an average stay of four to five days. The problem is, a surprising number – 1 in 7 people – are readmitted within 30 days to the same hospital due to complications or further illness. The Centers for Medicare and Medicaid Services (CMS) estimates that 20% of Medicare patients—1 in 5 people—are readmitted within 30 days, costing the government an additional $26 billion per year, of which $17 billion is for readmissions that could have been avoidable.
The readmission problem is so serious that a report from the Robert Wood Foundation in February 2013 wrote the following:
The U.S. health care system suffers from a chronic malady—the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving. Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital. But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn’t understand, and not taking medications or getting the necessary follow-up care. […] This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients.
As this report suggests, there are several causes of readmissions that can be eliminated by having a home care professional attend to the discharged patient.
The first of these is making sure the patient truly understands the health problem and treatment program. Many people, especially seniors, get discharged out of the hospital while not fully comprehending why they were there, what was done to them, and what regimen they need to follow in the coming weeks and months to get better. Even though discharge procedures always call for the doctor in charge and hospital officials to discuss all this with the patient, many people remain confused or simply forgetful when they arrive at home. In one study, for instance, it was shown that among discharged patients 65 and older who believed that they understood their discharge instructions, a full 40 percent were still unable to describe correctly the reason for their hospitalization. Nearly 55% did not accurately recall the instructions they were given about follow-up appointment. Hospitals have now recognized this problem and are trying to do a better job at ensuring that patients fully understand their situation upon discharge.
However, it is clear that having the support of family and a homecare provider can significantly reinforce the effectiveness of care after discharge and prevent readmission. A homecare provider can be an especially vital part of the team if family members work and are not available during the day to perform needed tasks for the patient. The patient must be able to do many tasks on their own, and if they cannot, having a professional home care provider around can help a great deal. These are things that a patient must be able to do:
- administer medications and obtain prescription refills
- Perform the actions required by doctors for healing, such as walking, exercising, standing, and so on
- Eat the medically-recommended diet for the condition and manage general nutritional needs
- Follow-up with any designated medical providers
A second reason that homecare providers can contribute a lot to prevent readmissions is they tend to boost a patient’s emotional wellbeing, as well as help maintain the person’s cognitive capabilities and activity levels, both of which play a strong role in healing, as medical science now knows. Having a loving, compassionate homecare provider around to talk to the patient, watch TV with them, or guide them in rehabilitation exercises or accompany them on therapeutic outings goes a long to helping people maintain contact with the world rather than lapsing into self-pity, apathy or even post-hospitalization depression.
Third, when it comes to medications, a home care provider can play a vital role in several ways. One is that many people are already taking drugs before going into the hospital, so when they come out they become confused by having to change medications. They may mix up pill colors, dosage levels, timing schedules, whether to eat or not with a pill, and so on. Also, new medicines can often have adverse side effects or the patient may simply reject taking them. A homecare provider can monitor the entire medication regimen and alert family members or doctors should something seem wrong.
In addition, a home care provider can accomplish many other tasks that the family may not be around or available to do:
- Conduct errands, grocery shopping, light housekeeping and meal prep
- Advise about home safety needs, such as recommendations about necessary changes to the home or bedroom, or specialized equipment needed;
- Perform any physical activities that the patient would have had to do but which are now too difficult
- Assist with all the ADL (Activities of Daily Living) that the patient cannot do after discharge, such as bathing, dressing and grooming, eating, and toileting.
- Transport the patient to rehabilitation and doctors’ appointments or family events.
Ultimately, the home care provider can be a key resource who can slowly guide patients back to as much independent living as they can handle following hospitalization. So if you have a loved one who has recently been discharged from the hospital, give serious thought to the many benefits that having a homecare provider around can bring to your patient and your family.
And if you run a homecare agency, take heart that your services are crucial to the wellbeing of people who probably do not want to return to the hospital.