Prevent Readmissions With Discharge Planning

Rebecca Hendren, for HealthLeaders Media , April 5, 2011

“In the United States, we value autonomy and your independence above all else,” says Popejoy. “But if you really think about it, my independence may impede upon your independence. If an older adult says ‘I’m going home no matter what and you have to live with it.’ And the child says ‘I can’t handle it right now,’ that older adult has the right to make that decision. The child also has the right not to participate.”

Hospitals are stuck in the middle, but have to support both sides. Hospitals also must look at the spouse and appraise the situation. If the main caregiver is a 5-foot 1-inch, 100-pound woman, how will she be able to lift her 230-pound debilitated spouse?

It’s important to consider what will happen because such situations lead to subpar, degenerating care that end up in readmission.

Popejoy concedes she doesn’t have the solutions, but that hospitals need to consider their options. She says when hospitals return patients to the community, it’s often a complicated process of care coordination to find sources to help older adults manage at home.

“Hospitals are not well placed to do that,” says Popejoy. Patients are admitted for relatively short times and it’s difficult to discover intricacies of living and family arrangements in a short time. “But hospitals will have to get better at partnering with different community organizations and performing solid handoffs and communicating with patients and families to build solid plans that work, otherwise patients end up back in the hospital,” she says.

Home health keeps patients for an average of two weeks. “That’s about the amount of time they are starting to become unstable again,” she says

She said hospitals must be realistic about discharge plans. Is the plan simply to get the patient out of the hospital? Or is the plan to get them out and keep them out? Hospitals are paying the biggest price for readmissions, but it will take even more effort to solve the problem.

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