Senior adults who spend time in the hospital are often send to a nursing home for rehabilitation. The assumption generally has been that, after a brief time of rehab, they’re ready to return home and resume independent living. But a just-released research report from the Journal of the American Geriatrics Society proves that a lack of help at home is problematic: seniors who fail to receive in-home health care after a rehab stay are more likely to end up being readmitted to the hospital. The important take-away: home health care is a crucial component in a senior’s recovery.
Home Care is the “Missing Link” in Reducing Hospital Readmission
We found the report about this research here on a website called Health in Aging. According to the just-published article, researchers examined hospitalization reports from nearly 68,000 seniors, all suffering from heart failure, to see how well they recovered following hospitalization and rehabilitation. “Older adults who are recovering from heart failure often leave the hospital to stay at rehabilitation facilities (also called skilled nursing facilities) before they return home,” the summary article explained. “However, healthcare practitioners know that the stress of the transitioning from hospital to skilled nursing facility and back to a person’s home can result in an older adult’s readmission to the hospital within 30 days after their discharge.” The research suggests that home health care after rehab is the “missing link” that reduces readmission rates significantly.
In the study, a team of researchers examined Medicare records for some 67,500 adults 65 and older, all of whom had been hospitalized for heart failure. All had been released from their hospital stay and immediately transferred to a skilled nursing facility for a period of “short-stay rehab” – the type of rehabilitative stay generally covered by Medicare. The goal of the researchers was to see if the rate of hospital readmission could be improved. Among all the patients whose records were reviewed, only about one in five – about 13,000 patients – received home health care following their short-stay rehab, while 80 percent did not. The study showed that fewer than 23 percent of those receiving home care ended up back in the hospital within 30 days, compared with nearly 25 percent of those who did not. This difference may not seem huge, but to the researchers it was both significant and unexpected, translating into thousands of extra days of needless hospitalization.
Offering Home Health Care to More Post-Rehab Seniors is Cost-Effective
According to the article from Health in Aging, the reason this outcome surprised researchers is that only the weakest patients tend to receive care at home. “Older adults who receive home health care after leaving a skilled nurse facility are more likely to have trouble getting around and other difficulties,” the article said. “They were also likely to have shorter stays in the skilled nursing facility, which means they had less time to recover from their illness.” The fact that even these frailer patients had better outcomes suggest that home health care is a cost-effective way to cut down on hospital readmission, especially at a time when skilled nursing facilities are being penalized by the Centers for Medicare and Medicaid Services (CMS) when patients released from short-term stays end up back in the hospital sooner than expected.
In the research summary which can be accessed here, the authors project that CMS will penalize nearly 11,000 skilled nursing facilities in fiscal year 2019 because too many of their rehab patients have been readmitted to the hospital within 30 days. “Despite our finding that patients discharged with [home health care] experienced decreased risk of readmission, only 20 percent were discharged with these services,” says the report. “This may represent ‘low hanging fruit’ for [skilled nursing facilities] searching for strategies to reduce readmissions and improve their performance in this program.” As one lead researcher summarized, “Recovery from a hospitalization can sometimes take longer than expected and the support provided by the skilled nursing facility and then home health care may be what vulnerable patients need to get better.” (Italics added)
The Best Idea is to Avoid Senior Hospitalization in the First Place
Putting seniors in the hospital often brings significant risks, as this article from a website called SeniorMatters points out. The article, which is titled “Elderly Hospitalization: The Cure May Be Worse than the Disease,” says seniors and their families have to be extremely wary of the dangers of a hospital stay. “With elderly hospitalization, whether due to illness or injury, the outcome may sometimes be worse than if they had not gone in the first place,” the article warns. “Although they may eventually recover from the illness or injury that first brought them to the hospital, chances are high that when they leave, they will be in worse shape than before they arrived at the hospital.” One Canadian study showed that about one-fourth of elderly patients (average age 71) “had an adverse health event occur either during a hospital stay or immediately afterward,” and that half of those events were preventable. It’s all too common for seniors “to go to a hospital for a minor injury (such as the complications from a fall) and leave several weeks later with a host of new problems” ranging from infections and other illnesses to memory loss, chronic weakness, and loss of balance. The biggest culprits, said SeniorMatters, tend to be lack of mobility and loss of sleep.
Avoid a Host of Age-Related Problems with Thorough and Careful Planning
According to Rajiv Nagaich of AgingOptions, the idea that home health care benefits seniors is hardly surprising – what’s more puzzling is that too few seniors receive it. “Home health care is an important benefit,” he says, “and if families plan ahead, they can experience the kind of positive outcome this article talks about. You can do it! But,” Rajiv emphasizes, “you have to prepare. If you follow conventional wisdom, which says that once you’re old there’s nothing you can do about it except go to a nursing home, you’re going to fail in retirement like so many people do.” This kind of preparation needs to start with an honest conversation involving all concerned parties, so when a medical crisis strikes everyone knows the part he or she needs to play. There are also ways to make sure you have funds available for home health care, but the time to set up those systems is well before the need arises, not after.
In the same way, a positive and secure retirement can be yours with thorough planning and preparation. At AgingOptions we call this planning process LifePlanning, and our approach is indeed comprehensive, weaving together all the key elements of retirement: family dynamics, financial preparedness, legal protection, housing plans and medical coverage. Rajiv Nagaich invites you to come learn more about LifePlanning at one of our free, information-packed LifePlanning Seminars, which he presents in locations throughout the Puget Sound area. Invest just a few hours and you’ll come away with your eyes opened to a new and exciting approach to retirement. For a calendar of dates, times and locations, visit our Live Events page and register for the seminar of your choice. It will be a pleasure to talk with you and share the power of a LifePlan. Meanwhile, age on!
(originally reported at www.healthinaging.org)