Discharge Planning - getting home and staying safe

  

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Discharge planning is a complex process that each patient must go through. The goal of this transition is to send patients home safely and to ensure patients stay healthy.  At the time of discharge, the patient should be provided with a document that includes language and literacy-appropriate instructions and patient education materials to help in successful transition from the hospital.  But the statistics demonstrate that this transition is not always successful.

Among Medicare patients, however almost 20 percent who are discharged from a hospital are readmitted within 30 days. The Joint Commission has provided guidelines for discharge so that these sorts of events don’t occur.

Discharge planning is fraught with challenges.  While the exact number of avoidable readmissions is unknown, between 9 and 50 percent of readmissions were judged to be preventable in studies involving retrospective chart review.  Research has demonstrated that in the long term, patients who are readmitted to the hospital within the 30 days have a longer and more difficult time getting healthy again.

Discharge information, both written and verbal, should be reviewed with the patient/family caregivers with an emphasis on assessing and ensuring comprehension. However, the pace in US hospitals today means this step is often rushed; leaving patients, caregivers and family members with their heads spinning and with a weighty responsibility on their hands. 

Because of climbing readmission rate, patients are relying more and more on private nursing care in the home.  Nursing care has been shown to reduce anxiety in patients, reduce medication errors and keep patients at home and safe. The Joint Commission has also published that home is the healthiest place for a patient to be.

It makes sense in this current healthcare climate to be as active in your healthcare management as possible. In New England, Hotelrecovery is one of the most successful private nursing care programs.  Regardless of what our client’s needs are or where they wish to recover, Hotelrecovery will build a personalized, detailed and comprehensive care plan that exceeds their expectations.

Financial Landscape Leads to Burned out Nurses & Increased Mortality

  

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 In 2012 Medicare spent $556 billion on healthcare with inpatient hospital costs comprising 25% of this spending and these costs are projected to grow by more than 4 percent annually in the coming years.   Medicare generally pays hospitals a set fee (DRG or diagnostic related group) for a each inpatient admission and diagnosis, so hospitals have significant financial incentives to reduce the length of stay of a given patient.  Bundling of care forces hospitals to accommodate these financial pressures by moving patients through hospital care and treatment faster than ever (Wachter et al. N Engl J Med. 1996;335:514-517). This increased throughput however been shown to not be without risk.

New research from Dr. Needleman of Harvard Medical School demonstrates the risk of death among hospital patients increased when nurses had a high turnover of patients during their shifts (N Engl J Med 2011; 364:1037-1045).  This research is consistent with other groups which have consistently demonstrated the benefit of addditional nursing care: Increased nursing care for patients from additional registered nurses were associated with lower rates of ‘failure to rescue’ defined as pneumonia, shock or cardiac arrest (Silber et al Anesthesiology 2000;93:152-63 & Needleman et al N Engl J Med 2002; 346(22):1715-22).

Registered nurses oppose the trend towards rapid discharge and shorter hospital stays and as a result have become increasingly dissatisfied with the working conditions in hospitals. They report that they are spending less time taking care of increasingly ill patients and believe that the safety and quality of inpatient care are deteriorating (Buerhaus et al. Nurs Econ 2001;19:198-208). In an article in the August 2012 issue of the American Journal of Infection Control, Dr. Jeannie Cimiotti and colleagues identified a significant association between high patient-to-nurse ratios and nurse burnout resulting in increased urinary tract and surgical site infections. Furthermore, RN’s in general are an aging work force and over the next twenty years a large numbers of RNs are projected to retire which may add to the existing relative nursing shortage (Buerhaus et al. JAMA 2000;283: 2948-54).

Perhaps not suprisingly, risks for patients extend beyond the inpatient admission into the discharge phase.  Highlighted in the document (which document? )  is that nearly 20%, or 2.3 million of hospitalized Medicare beneficiaries were readmitted to the hospital after 30 days over a one-year period.  These incidents most frequently occur when a patient moves from a hospital or physician’s care to home without proper information or preparation. The risks become greater as patients are released from traditional health care settings quicker and with higher acuity of illness, surgical procedure, or disease.  Following discharge from a hospital, it has been reported that 19%-23% of patients suffer an adverse event, most frequently an adverse drug event (Forster et al. J Gen Intern Med. 2005;20:317-323). In a further study, primary care physicians reported being unaware of 62% of the pending test results that returned after discharge, of which 37% were considered actionable. (Roy et al CL, Intern Med. 2005;143(2):121-128).  

With Federal financial constraints leading to the increasing work load of our nurses, a higher burn out rate and poorer outcomes for out public, where does this leave the American patient? The Joint Commission recently published a statement on home care highlighting, “home care is a key step toward achieving optimal health outcomes” (Home – The Best Place for Healthcare Joint Commission, 2011).

Hotel Recovery, is a comprehensive, private healthcare company located in Boston which provides best Healthcare practices to our clients.  We create a seamless transition from the hospital to home, assisted-living facilities or even hotels; ensuring you receive ongoing attention no matter what you needs might be. Hotelrecovery can supplement the hospital nursing staff with private providers of nursing and healthcare services and transition to or enhance patients recovery following hospital discharge. Under board-certified critical care physician direction, Hotel Recovery assembles a custom care team of registered nurses and or allied health care workers and creates healthcare delivery solutions in accordance with each client’s needs.  Each member of our staff is a top professional chosen from Boston’s best healthcare providers. Because we are not constrained by reimbursement or insurance restrictions we can provide the time and care our clients typically cannot receive in a managed care setting. Hotel Recovery helps you recover-  faster, safer, and with all the service amenities that you would expect in a five-star hotel.  Please call to discuss how Hotel Recovery can help to enhance and de-risk your health care issues today.

Alzheimer’s Harder to Detect in Elderly

  

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A new study suggests that symptoms of Alzheimer’s may be harder to detect in patients over the age of 80. The study tested the relationship between age-related brain shrinkage and Alzheimer’s correlated memory loss. It used just over 100 Alzheimer’s patients and 125 dementia-free people who were grouped by age.

These participants then underwent a series of brain tests with scans that looked at attention, information processing speed and memory.

“People in both groups had similar levels of overall cognitive impairment, but the pattern of changes associated with Alzheimer's disease seemed to be less noticeable in very-old patients than in the young-old”[1].

Compared to other younger patients, the immediate memory and processing speed in very old Alzheimer’s patients was less abnormal indicating that it may be harder to diagnose. 

The study also demonstrated that 80+ Alzheimer’s patients had less thinning of certain areas of the cerebral cortex and cerebellum than the younger patients. This also supports the “hard to diagnose” conclusion because thickness of these brain areas decreases in everyone with age so the differences aren’t as noticeable.

Antidepressants Not Better than Placebo for Alzheimer’s

  

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A new study revealed that two commonly prescribed antidepressants for dementia patients are not better than a sugar pill for reducing depression symptoms in Alzheimer’s patients.

This study published in the Lancet tested Zoloft (sertraline) and Remeron (mirtazapine), which are both generic antidepressants that have generated more severe side effects than placebo. These side effects have led researchers to suggest that these types of medicine should be only used in dementia patients who cannot be treated in a simpler fashion.

The study only tested around 300 patients but was still the largest placebo-controlled trial to date on antidepressants in dementia patients.

More than one-fifth of the 35 million people around the world who have dementia have also been linked with depression symptoms, making this study immensely important. “Alan Manevitz, M.D., a psychiatrist at Lenox Hill Hospital, in New York City, agrees with the authors' conclusion that doctors should consider nondrug treatments before prescribing antidepressants to depressed dementia patients”[1]. 

This study is a key step forward yet it is surely not a final statement on the subject. It was a bit small and the findings weren’t diverse enough to apply to a large population of patients. Hopefully more progress will be made on this issue in the future.

Medicare Premiums to Drop in 2012

  

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The Obama administration announced another piece of good news for seniors today: there will be no increase in Medicare premiums and these fees for prescription drugs will actually drop a bit.

“Overall, the average premium cost of the Medicare Part D prescription drug plan in 2012 will be about $30, a modest decline from $30.76 paid out on average in 2011”[1]. Many will ask “how did this happen?”. The answer is that Medicare’s drug benefits program is being aided by competition from private insurers and increased use of generic medicines. And experts predict that the prices may continue to drop as more big-time drugs become generic over the next year few years.

DHHS (Department of Health and Human Services) secretary Kathleen Sebelius credited President Obama’s health care reform efforts for being crucial in these cost savings. "The Affordable Care Act is strengthening a very critical Medicare program and helping million[s] of seniors and Americans with disabilities get the care they need," she said. "Thanks to the new discounts, beneficiaries are saving hundreds of millions of dollars in the Medicare Part D coverage gap, known as the donut hole, at the same time as Part D premiums are falling”. 

Although this was big news, experts cautioned that much more work needs to be done. Sebelius said that there were still “critical” gaps in coverage especially with prescription drugs. Hopefully this trend of progress will continue and this will make life easier for the elderly everywhere.

Progress with Blood Tests for Alzheimer’s

  

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Scientists are getting closer and closer to a critical milestone in diagnosing Alzheimer’s patients. They are extremely close to succeeding at creating a blood test to screen people for the disease.

Currently, Alzheimer’s is diagnosed only after people start having memory problems or unexpected change in behavior. They then undergo an in-depth medical interview, a memory assessment test and occasionally an MRI to look for brain shrinkage. The problem is that these processes are overly expensive and impractical for routine use.

That’s why two recent studies are being hailed around the medical world as a large step forward in Alzheimer’s research. Australian researchers reported a few weeks ago that their blood tests showed more accuracy than ever seen before when tested with over 1000 patients. “The test correctly identified 83 percent of people with high amyloid levels and correctly ruled out 85 percent of people without this condition”[1].

The other study used blood tests to screen for autoantibodies (special markers in blood) and showed even better experimental results. “The blood test correctly detected Alzheimer's disease in people already diagnosed with the devastating brain disorder with 96 percent accuracy, according to the researchers. The test could also distinguish who didn't have the disease from a control group of non-affected adults with 92.5 percent accuracy”[2]. 

This research is a huge step forward but the scientists cautioned spectators saying that there is still a long way to go. Let’s hope that future studies like these continue to show as exciting and ground-breaking results.

Advantages of Private Duty Nursing

  

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A recent blog post talked about some factors behind healthcare’s move home. Today, we’ll go more in-depth on a similar subject and outline some of the biggest advantages of opting for private duty nursing over hospital care.

As mentioned before, there is truly nothing like the comfort and security of your own home anytime, whether you’re a healthy child or elderly person recovering from illness. Many studies and extensive research show that even if you have a chronic illness, living at home with private home healthcare may be your best option for a swift and smooth recovery.

Some of the benefits of private care include:

“-         Provides individuals needing care with dignity and independence.

-          May help prevent or postpone hospital or nursing home care.

-          Allows maximum freedom and comfort for the individual.

-          Offers individualized care tailored to the needs of the individual and family.

-          Provides professionally supervised services

-          Supports families while keeping them together.”[1] 

Overall, if any of these benefits appeal to you or you’re just curious for more information, you should click the “Contact Us” tab above. HotelRecovery has offered quality private home care for over a decade and is the perfect local company if you want to recover at home.

Debt Ceiling Passes – How Does It Affect Seniors?

  

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The debt ceiling bill passed Congress yesterday which is good news for the country as a whole but many seniors are wondering how it will affect them. With all the horse-trading and compromising finally over, the news looks good (at least in the short term) for the elderly.

Most major programs of interest will be protected under the deal including Social Security, Medicaid, veteran’s benefits and pensions, civil and military pay and programs for women, infants and children. The deal does not raise taxes (due to Republican insistence) and will cut spending by over $900 billion starting in October.

What happens after this bill remains to be seen. A bipartisan committee has been tasked with finding another $1.5 trillion in savings later this year and that could definitely affect some of the aforementioned programs. Seniors may want to hope that Washington continues to struggle with compromising because if the committee fails to reach an agreement, automatic cuts would occur and Social Security would be safe again.

Everyone should be glad that a government shutdown was avoided but this process left an ominous future for new agreements and put many important programs at risk. We’ll just have to wait and see.

Why Healthcare is Moving Home

  

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Home healthcare is becoming an increasingly viable and even preferred option among patients today. In places around the country from New Mexico to New York, home health agencies are providing a huge variety of care services which focus on coordination and support for the individual.

Steven H. Landers, M.D, said “that the venue of care for the future is the patient's home, where clinicians can combine old-fashioned sensibilities and caring with the application of new technologies to respond to major demographic, epidemiologic, and health care trends”[1]. He isolates five major trends which are making home healthcare preferable for many including aging, epidemics of chronic diseases, technological advances, health care consumerism and increasing health care costs.

First, the aging population of the US will result in more adults having limitations on their activities, making leaving their homes for hospital care difficult. Therefore, home healthcare options have improved access and helped prevent complications due to hospital confinement such as delirium and falls.

Second, epidemics of chronic disease have become bigger concerns since around 90% of adults over the age of 65 have at least one chronic condition. The Chronic Care Model concludes that since patients manage their diseases at home, support and recovery are likely to be enhanced when care is provided there as well.

Third, advances in portability of medical technology have increased the viability of home health options. This has opened up the field and allowed nurses to treat patients in unexpected places already and should only improve as capabilities expand in the coming years.

Fourth, health care consumerism means that patients are looking for the best deals and that has pushed care to more convenient locations as well. Patients and caregivers want convenience and privacy, and as care models are developed to bring high-quality care home through the front door or mobile device, they may well surpass hospitals.

Lastly, in-home care is often much less costly for patients and can be more desirable which offers everyone a win-win solution. Landers concludes that “in one study of a hospital-at-home approach, patients who received care at home had lower rates of consultations, procedures, and use of devices than their hospitalized counterparts but had similar or better clinical outcomes” [1].

Urinary Tract Infection Rates in Hospitals

  

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Yesterday we blogged about the growing problem our healthcare system is facing with hospital-acquired infections. Today, we’ll investigate a bit further into these infections by examining urinary tract infections which are most common HAI. According to recent statistics, UTIs account for around 40% of all hospital-acquired infections which makes them crucial to stop.

Recent studies have concluded that “the risk of infection increases as the duration of catheterization increases”[1] so the best solution may be to reduce patients’ length of stay in hospitals. The problem is that less “than 1 in 10 hospitals in this country used [the simple methods] for preventing unnecessary catheterization”.

This is dangerous because urinary tract infections like other nosocomial infections increase morbidity and mortality, prolong hospital stay and increase patient care costs. The methods of preventing these infections are hazy and not fully agreed upon which makes patient care tough. 

Patients and their loved ones can do their part to decrease the chance of contracting a UTI. While in the hospital, patients are advised to ask their health care provider every day if the catheter is still necessary. The CDC also has guidelines for patients, and recommends that patients do the following when coming home from the hospital with a catheter still inserted:

- Make sure to ask questions so as to understand how to care for a catheter once home from the hospital

- Contact a doctor or nurse immediately if any symptoms of a urinary tract infection develop, such as a burning pain in the lower abdomen, fever, or an increase in the frequency of urination

- Always clean hands before and during catheter care

- Keep urine bags below bladder level

- Do not tug or pull on the tubing, or twist or kink the tubing

While a catheterized patient is recovering at home, highly-trained health care providers will be able to monitor a patient’s catheter, preventing infection and giving peace of mind to patients and their families.