Hospital’s not the enemy with the discharge process.
“Hospital follow-up falls short”, was the headline from the Sunday’s (February 24th, 2008) Sacbee (Sacramento Bee News). The sordid story of how unsuccessfully hospitals are dealing with the transition process of discharging elderly patients home, or to a skilled nursing facility (SNF , aka: Nursing Home). The article tells of the inadequate planning carried out when discharging patients home, with a focus on the elderly. It is a story of fragmented care.
Many patients go home from hospital to recuperate sicker than they used to. Hospitals have been treating patients to get them over the acute phase of their illness or injury, and then send them home to complete their care plan in either a home or outpatient setting. Typically outside services are arranged for home care through the local visiting nurses association (VNA) or other agency to help the newly discharged patient cope with being at home.
“Time and time again, we see people have been told it’s time to go home and they don’t feel ready,” said Jodi Reid, of the California Alliance for Retired Americans, a San Francisco-based advocacy group.
On my website (Mike’s Viewpoint), I have posted a number of writings regarding the care of the elderly: Silver Tsunami, When I’m sixty-four…, and Elder care as a growing market. The statistics are out there. The 87 year-old age group is the fastest growing segment of society. Many elderly have family members that geographically dislocated and are not near by to assist them in providing after-hospital care. Several elderly patients live alone and do not have community support systems established. At the end of the day the elderly patient faces a number of challenges regarding their healthcare.
The article raises awareness to the growing problems that exist with coordinating follow-on care services for the elderly patient. Depending on the needs of the patient at the time of discharge, the requisite amount of community resources needed to be employed to ensure a successful recuperation period can be extensive. Several problems exist here, with the main one being compensation. Hospitals are not able to bill Medicare for the amount of time spent coordinating services for patients that are ready to go home. Additionally, any services that a patient requires in the home setting must be able to be paid for. Medicare, Medicaid, and private insurance companies have very clear policies regarding what they will and will not reimburse hospitals and outside agencies for. Once again the issue of healthcare boils down to dollars and cents. The business of healthcare has decided what each of us is worth.
That being said, healthcare organizations are not the main target as the Sacbee article alludes to. In this case the smoking gun should be pointed at the insurance carriers. By refusing to reimburse a hospital for the time spent in coordinating care for patients, insurance carriers have shown that the discharge process is unimportant. How can hospitals invest resources into coordinating a patient’s care, and expect this service which can be quite complicated to be done gratis?
About the Author
Mike Pringle is the creator of Mike’s ViewPoint, where he provides his perspective on various Healthcare issues. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. Mike has held positions ranging from department staff and Nurse Manager to Executive positions.
