If hospitals don’t want to find discharged patients back on their doorstep again soon, they should see to it that those patients aren’t sent home unable to care for themselves.
According to a recent report, discharged patients who developed a new activity of daily living disability and had no or insufficient home help had a two-fold higher risk of hospital readmission than those with unmet needs before being hospitalized.1
A simple question such as ‘do you have enough help at home for your self-care needs,’ if asked at time of hospital discharge, could potentially modify the patient’s risk of rehospitalization, it appears.
It’s possible this question is not asked often enough, as an unrelated study, published in 2010, found that, overall, only 10% of patients were discharged from community hospitals to home care.2 (The 2010 report does not tell us what percentage of patients in this nationally representative sample needed home health but failed to get a referral.)
The new publication on disability is based on more than 500 interviews (linked to Medicare claims) with patients who had been hospitalized within three months of the interview and who said they had one or more problems with activities of daily living (ADLs). These patients were then followed for a year after their interview to assess their likelihood of being rehospitalized.
The presence of a disability was defined as needing human help or equipment to complete a task such as bathing, dressing, eating, toileting, getting out of bed/moving around the room. An unmet need was defined as not receiving any help or having to postpone a task because the patient needed more help.
Predisposing factors for rehospitalization were older age, presence of diabetes, more than one previous hospital admission, three to five ADL disabilities, and more than one unmet need for an existing or new ADL disability
These findings support the authors’ conclusion that “eligibility for transitional care should include consideration of whether a patient has sufficient ADL help after returning home from a hospitalization.”
1. DePalma G, Huiping X, Covinsky KE, Craig BA, Stallard E, Thomas J, Sands LP. Hospital readmission among older adults who return home with unmet need for ADL disability. Gerontologist 2012; published before print, August 2, 2012.
2. Wier LM, Levit K, Stranges E, Pfuntner A,Vandivort R, Santora P, Owens P, et al. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2008. Rockville, MD: Agency for Healthcare Research and Quality, 2010 (http://www.hcup-us.ahrq.gov/reports.jsp), accessed August 18, 2012.
Only the obviously debilitated get home care post hospitalization as do those already on service get it extended. Often they need this service to continue. And even those with plenty of help at home, family, etc still get HHA services that they only get because the families put up such a fuss.
But the level of analysis provided doesn’t meet the threshold of need. And who is doing the case finding? SW and case managers? They seem better motivated to open a bed (DRG) rather than take the extra time needed to create a plan (even if it means they will get that pt back).
Asking a patient if they need or want home care is often going to get you a no because people are unrealistic about their potential for providing self care or are delusional in their confidence of their partners ability to meet their needs.— Iralarry / September 13th, 2012 at 2:29 pm