Avoiding a Return to the Hospital

As Americans grapple with how to measure and pay for quality care, hospital readmissions have moved front and center into the conversation. Last year, for example, Medicare began to impose financial penalties on hospitals with substandard readmission rates for certain problems-that is, too many patients who returned to the hospital within 30 days of their discharge for heart attack, heart failure or pneumonia. According to a recent study by the Robert Wood Johnson Foundation, 1 in 8 elderly surgical patients is readmitted to the hospital within the 30-day window.

Preventing unnecessary readmissions isn’t solely the problem of the hospital or its caregivers-patients, too, have a responsibility to ensure that their transition home and ongoing care are successful. Our newsletter, “You Can Go Home Again (from the Hospital) But There’s a Lot You Need to Know First,” discussed several aspects of the transition process. And a recent story published in the Los Angeles Times offered additional suggestions on how you or a loved one can avoid returning to the hospital.

Understand your medications.

According to The Times, Yale University researchers found that more than 8 in 10 patients discharged from the hospital had medication errors, often because they didn’t understand changes made to prescriptions they were familiar with.

Sometimes a dosage is changed, a drug is discontinued or another is added. To avoid confusion, write down any change in a medication regimen, and the names of all drugs.

Establish a follow-up plan.

According to the Johnson Foundation report, less than half of patients visit their doctors within two weeks of leaving the hospital despite advice to do so. That might be less a matter of ignoring directions than being under the influence of drugs and pain on discharge.

The friend or family member/patient advocate should keep track of the follow-up appointments and make sure the patient is aware of them in advance. Managing the discharge doesn’t cease just because the patient has settled back into his or her routine.

Be mindful of the nonmedical issues.

Some patients live alone. Some lack transportation. Some can’t prepare meals. Many hospitals have care coordinators who can identify local programs to address such needs. If you or your loved one has limitations that can compromise care, make sure the coordinator or hospital’s patient advocate is aware of them.

If a care coordinator isn’t available, consult websites such as CarePages, Caring Bridge and Lotsahelpinghands. All were established to identify local patient support networks and help people connect with them.

Private home-care services are available as well for both medical and nonmedical needs. Nurse Next Door, according to The Times, is one example, the cost for which begins at roughly $25 per hour.

Know your resources.

Because home-care services often aren’t covered by insurance, even for the elderly who are likely to need them most, it’s worth checking with your state’s Medicaid program to see if you qualify for its low-income assistance for in-home help. Other resources include:

• BenefitsCheckUp, an online service of the National Council on Aging. It helps older adults determine their eligibility for federal, state, local and private benefit programs.
• Family Care Navigator, a service of the National Center on Caregiving. It identifies programs through the country that offer a variety of services.