By practicing preventative health care, older adults can reduce the likelihood of an expensive and overwhelming stay in the hospital. The Medicare Payment Advisory Committee released a study showing that nearly 60 percent of Medicare patient ER visits, and 25 percent of their admissions as in-patients to hospitals are potentially preventable. These hospital admissions are not necessarily the fault of doctors who are too eager to admit patients, but generally a result of mismanaged chronic illnesses.
Patients who seek regular outpatient treatment, and routinely take all of their medications for chronic illnesses like diabetes or congestive heart failure, are much less likely to be admitted. While receiving regular medical care before a hospital stay is important, it becomes even more essential after a hospitalization; this greatly helps to avoid readmission. The Center for Medicare and Medicaid reports that nearly one in five Medicare patients will be readmitted to the hospital within 30 days of being discharged. What is worse, almost a third of Medicare patients don’t seek or receive essential follow-up care after a hospital stay.
Mismanagement of chronic illnesses, and failure to follow discharge instructions are central to high rates of avoidable senior hospitalizations. So, why are older adults not getting necessary treatments or following their discharge orders?
- Older adults don’t have easy access to transportation, and getting to a medical appointment can be difficult.
- While in the hospital receiving their discharge instructions, many seniors are overwhelmed by the situation, a new diagnosis, or overly complicated medical terminology, and may not later understand or remember their discharge instructions.
- Medications are confusing. Many older adults take several types at different times, and on different days. New medications, in addition to old medications, can create a confusing routine that they either do not understand, or simply have a difficult time following.
- Many older patients are alone when they go home. When patients need assistance or get confused about their medications, they have no one convenient to call for simple assistance or a quick answer to a question. Minor confusion about a treatment plan can easily lead to mismanagement of an illness.
Older adults are an at-risk group for hospital admissions, and not all hospital stays can be avoided. However, there are some simple steps that can be taken to reduce chances of being admitted.
- Using a teach back. When reviewing medical care instructions with seniors, it is much more effective to ask patients to explain their treatment in their own words; rather than asking if the patient understands. A study at Oregon Health & Science University in Portland showed that simply using this method, and reducing the reading level of instructions causes an 11 percent drop in readmission rates of cardiology patients over an 18-month period.
- Create a discharge plan. Dont just take medical instructions home; instead create a detailed and written plan on how you are planning to follow the discharge notes. Write down clear medical instructions, when you are going to schedule your follow-up appointments, and how you will be arranging transportation to those appointments. You should then post the plan prominently in your home.
- Medication management. Create a written list of your medications, what they are for and exactly when they should be taken. This is not only for you, but also for your physician. Many patients do not know which medications they are taking, and there isn’t always clear communication between hospitals and family physicians. By providing a complete list to your primary physician during your follow-up appointment, you are also ensuring better care.
- Consider temporary assistance. Some assisted living communities welcome short-term stays. During recovery from a hospital visit, a full-time staff member can help you deal with new responsibilities and your changing regimen. Most offer transportation to medical appointments, assistance with medication management, a medical staff member, an emergency call system, and provide meals.