What’s the Hurry?
Why hospital patients are discharged quickly, and how this affects elderly patients’ perception of the hospital.
It happens every day across the country – a patient is informed by a hospital physician, nurse or discharge planner that they are being discharged the following day. For most people, the news of being discharged is met with excitement! Back to their home, back to work, and resuming their daily routine.
For an elderly person, however, it can be the most frightening news, especially since many will need a brief stay in a skilled nursing facility (SNF), commonly referred to as a nursing home. The last thing anyone wants to hear from a hospital is that you can’t go home, because you need further care in a nursing home. It happened a few years ago to my friend, Ruth. Her husband, Mark, had an accident while trimming a tree and suffered fractures to his leg and both ankles. The good thing was that Ruth worked in a nursing home and was familiar with the entire process, and Mark’s discharge and subsequent rehabilitation in the nursing home went fairly smoothly. However, most people never think they’ll need a nursing home, and the elderly are no different. Remember, we’re as young as we feel. Why research nursing homes if you think you’ll never need one?
In a study published in the Journal of the American Geriatrics Society https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14988 the authors surveyed elderly patients’ experiences during the hospital discharge planning process when they were being discharged to a skilled nursing facility for post-acute care. The study found that the majority of elderly patients, and their families, had a negative perception toward the hospital discharge planning process. They felt rushed in the decision making process, and that the hospital provided them little help, during a time of crisis, to choose an appropriate skilled nursing facility.
While most of us working in health care aren’t surprised by the results of the study, I wondered about what this says to the public. That hospitals don’t care about the elderly, or it’s because the people in the study are older and don’t understand the discharge process?
As a health care professional I view this as a more extensive issue – it’s not a hospital issue and it’s certainly not the fault of an elderly person. Instead, I think it’s an education issue. I want to share my knowledge with you in this blog, because you need to know, and I know you can handle it!
In my experience, there are 4 factors at play during the hospital discharge process that make the discharge notification seem too quick and that the patient, especially an older patient, isn’t given enough time to prepare:
- Medically Stable vs Diagnosis & Treatment
- Conflict of Interest
The reimbursement of health care costs has changed from a “fee for service” structure to a “prospective payment” structure. Under the fee for service structure, hospitals, as well as other health care providers, were reimbursed dollar for dollar for the cost it took to provide treatment and care.
Under the prospective payment structure, the insurance carriers set the reimbursement amount based on the procedure and other criteria. If the treatment and care costs the hospital more for a particular patient, the hospital will not be reimbursed for the difference.
Of course there are exceptions that occur, but a hospital has to closely monitor that the treatment and care provided falls within what the patient’s insurance will cover.
Medically Stable vs. Diagnose & Treatment
Not only do hospitals have to manage treatment based on each insurance carrier’s reimbursement system, but there is often a shortage of beds for all the patients that need care. There is often a push to discharge patients, as soon as medically possible, in order to open up the bed for another patient in need of treatment.
Most people admitted to a hospital think that they will stay there until they are well enough to return home. However, with the limits imposed by the prospective payment system and the pressure to open beds for new patients, hospitals have been required to make a major shift.
Now, the hospital’s main goal is to stabilize a patient to the point that they are able to be discharged, with follow-up diagnosis and treatment coordinated through the patient’s primary care physician. This may include more diagnosis and treatment on an out-patient basis, or by a long term care provider, such as a nursing home or home health agency.
While a younger person can more easily handle follow-up diagnosis and treatment on an out-patient basis, elderly patients may be too weak to manage alone, or may not have the family support system to provide the level of support needed. It comes as a surprise when the hospital doesn’t keep them until they are completely well, but instead gives them 1-3 days to find a nursing home for further treatment and rehabilitation. It happens all too often, which is one of the reasons I created SNF Right Now!™courses. Instead of be stressed and not knowing what to do, you’ll have everything you need right away!
Conflict of Interest
In the study referenced earlier, elderly patients and their family, were upset that the hospital wouldn’t recommend a specific nursing home to them, or help them to select a nursing home.
Regulatory requirements don’t permit a hospital to recommend one nursing home over another. The hospital is required to promote the patient’s choice in selecting a facility, and must avoid recommending one facility over another. To do so would be considered a ‘conflict of interest’ meaning that one nursing home benefits as a result of the hospital only recommending that nursing home.
To avoid the appearance of any conflict of interest, hospitals will provide the patient and family with a list of the area nursing homes only. It isn’t in the hospital’s capacity to help the patient or family any further than providing basic information.
During the hospital admission process, a patient or their family member is asked about the amount of support available to the patient at home. For example, a patient or family member may tell the hospital that a family member visits the patient daily, and that the family helps the patient with their medication, grocery shopping and transportation to and from physician appointments. But, the level of assistance a patient requires at discharge is usually much more involved than prior to admission. A family member who visits daily and helps with medication may mean to the family that someone stops on their way to or from work to check on their Loved One and to remind them to take their medication. For the hospital, they may think a family member visits daily and can stay as long as needed to care for the patient. Imagine the frustration, on both sides, when the hospital explains all the follow-up diagnosis and treatment the patient will require, and the family indicates that they aren’t available to the degree the patient will require! Thus, the scramble begins to find the patient a short term stay in a nursing home.
Now that you have a better understanding of the four factors that can drive a quick discharge, how can you avoid this from happening to a Loved One? Plan ahead and be prepared.
In your planning I suggest, at the very least, you become familiar with the nursing homes in your area. Know where they are located and how far they are away from your home. Ask your friends if they have experience with any of the nearby nursing homes, and what one they would recommend.
But finally there’s a better way – I’ve done the work for you! Check-out my digital, online courses. There’s a course that will meet everyone’s needs, whether you need a step-by-step guide through the entire process, or just some detailed information, I’ve got you covered. They’re quick, user friendly courses that I designed to take the mystery out of the entire process. Every course is filled with all kinds of helpful hints and ‘how-to’ guides that I’ve developed over the course of 30 years working in long term care. And if you need individualized coaching, contact me for a personal consult.