Reducing hospital readmissions is a noble goal for any long-term care facility, wound care practice, or other medical professional to work towards. Going up through the supply chain of medical care, we even find this shared vision amongst the professionals and companies which ensure that necessary prescriptions, medical products, and other shipped goods, land in the right hands at the right time. In short, reducing hospital readmissions represents a major community responsibility, and one that shouldn’t be taken lightly.
However, in long-term and wound care, this goal isn’t always so easy to achieve.
Nursing homes, long-term care facilities, and other medical care-adjacent companies can greatly help themselves and their communities’ health infrastructures by adopting practices which reduce the number of residents who have to be readmitted to hospitals and other healthcare facilities. This phenomenon is known as re-hospitalization, or sometimes less formally as bounce-backs.
Hospital readmission is a very real and significant problem in America today. Studies have shown that one in five elderly patients are readmitted to their healthcare facility within 30 days after departing, and one-third of patients 65 or older are readmitted within three months. This results in Medicare costs that exceed $17 billion total every year.
In response, some insurers are adopting harsh penalties on patients with high readmission rates. As a result, healthcare providers are reassessing their relationships with long-term care providers in an attempt to address this issue. Beyond the issue of the need to improve patient care, this comes with very real consequences for home care agencies. The ratings awarded to such agencies by the Centers for Medicare and Medicaid Services (CMS) are also affected by readmission rates, and an agency with poor ratings in this area can dramatically decrease its reimbursement levels.
Greater Attention to Patients with High Risk of Re-Hospitalization
An effective method for dealing with this problem is for caregivers in long-term care facilities to develop ways of identifying those patients who are most likely to experience difficulties, and to enact measures to help them before these situations develop into crisis situations. A few specific techniques for achieving this are outlined below.
When patients first return home after a stay in a healthcare facility, they may have difficulties readjusting to their surroundings. This, in turn, increases the risk of falls and other injuries that may result from mobility issues. Caregivers can reduce these risks by looking for ways to simplify the spaces that recently-returned residents have to navigate. Similarly, caregivers should ensure that a resident has readjusted to life at home before undertaking physical therapy or other activities that may be overly-taxing for them.
Research has indicated that over 30% of bounce-backs among elderly patients result from the mismanagement of medications. Facilities can address this by reconciling medications often, and by providing reminders to their residents regarding the use of their medications.
Language barriers between a patient and staff at a long-term care facility, or patients whose cognitive condition makes it difficult for them to understand instructions, may leave them unwilling or incapable of following their caregivers’ guidance. This can be circumvented by asking the resident to repeat any instructions they are given, so that the caregiver can be certain that they were properly heard and understood.
Practical Techniques to Avoid Re-Hospitalization
The installation of sensor technology in residents’ rooms can also allow staff to react more quickly in an emergency, thus reducing the likelihood that minor incidents may develop into more serious issues. Data suggests that equipping residents’ homes with sensors can reduce bounce-backs by nearly 50%. Facilities can also make it easier for residents to receive non-emergency visits from healthcare providers within the facility itself, rather than going to a hospital.
Caregivers at a facility should also be provided with clear lines of communication with other staff members to ensure that everyone is getting the information they need to address the needs of patients who are more acutely at risk. These communications should be well-documented, both to ensure the accuracy of the information exchanged, and to place responsibility where it belongs when something does go wrong. This can also be aided by establishing electronic health record protocols for the residents in a facility. These methods can also help to guarantee strong clinical oversight, which further ensures success in at-home treatment.
When re-hospitalization does occur, facilities should be prepared to examine the reasons why it happened in order to figure out what changes might have led to a better outcome for the patient. Statistics suggest that approximately 75% of hospital readmissions could have been avoided with better procedures in place.
Lastly, care facilities need to ensure that all of their staff are adequately trained to deal with a range of medical issues. Facilities who trained their caregivers in CPR and infection control, for example, saw 24% fewer readmissions in the first year after training and 41% during the second year.
Benefits of Treating Patients within a Long-Term Care Facility
Besides avoiding penalties, long-term care facilities have much to gain by addressing the problem of re-hospitalization among their residents.
Patients who spend less time outside the facility have more opportunities to participate in scheduled activities such as hobbies, physical therapy, and social interactions. A routine visit by a healthcare provider at a facility can be as brief as 15 minutes, leaving the patient free to go about his or her life as normal. This is as opposed to in-hospital treatment, which can often take an entire day or more.
Secondly, if residents are seen by healthcare providers in their homes, they can usually be accompanied by their regular facility nurse. This can greatly aid communication and ensure that the provider receives as much information as possible when planning treatments for a patient. This also reduces the time it takes to identify wound-related complications. In some cases, the patient may not be able to communicate at all with the healthcare facility, so the nurse may be the only person with necessary information about their needs.
Additionally, allowing healthcare providers to see their patients in a facility greatly reduces the transportation costs they would otherwise incur by taking the resident to a clinic and back. If this is the case, the facility must then undertake the fees associated with the wound care visit, as well as the cost of seeing the healthcare provider. When healthcare professionals can see their patients at a facility, it eliminates all costs apart from the price of the professionals’ services. It also greatly reduces the amount of time that a patient must wait before he or she can receive treatment for an injury.
These are just some examples of the steps that long-term care facilities can take to prevent and decrease hospitalizations, improve the level of service they provide to their residents, and reduce their own risks and costs. Developing better strategies for preventing rehospitalization and allowing healthcare professionals to see residents in their homes are both a win-win for everyone involved.
