Monday, December 08, 2014
Taking care of older people between the settings
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!