Monday, December 08, 2014

Taking care of older people between the settings

Home, assisted care, rehab, hospital, nursing home, hospice--Older people don't necessarily have a health problem, cure it and go back to "normal." Sometimes there are steps.

I wrote a chapter of a book on care between the venues--30 years ago--and apparently these problems still exist.

A team at Johns Hopkins is now looking at this issue. One big problem area is the new "pay for performance" standards under the health care law--if a patient has to return to the hospital in a certain period of time, the hospital has to eat the cost.

I know there are also issues with how long the patient has to be in the hospital to get rehab hospital or nursing home bills reimbursed under Medicare. Sometimes this means a long hospital stay for fiscal reasons.

The handoff can also be garbled. Most people have experienced this--cursory ER directions on what to do when you get home--sometimes older patients (actually any patients) don't know whether to take the prescribed meds in addition to their regular ones or substitute--often this is not clear.

Also patients may not know what home care is available--or what supplies to get and where.

This is the beginning of the list.

I say let's emphasize this more in health care planning. Delirium and confusion can affect older people from being an a hospital setting--especially intensive care. Figuring out what next is a challenge.

Once we took Mom back to assisted care and they gave another patient her pills. Dandy!

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