Seniors that receive treatment in a hospital setting are often the frailest and have the most complex medical conditions. On top of this, it is well known that elderly with a recent hospital admission are at highest risk of having a readmission.
This article will talk about the factors that are related to senior hospital readmissions and will highlight things that can be done to reduce this risk.
Illness or injury may still be an acute problem
Hospital beds are in short supply, and patients are often discharged when they become medically stable enough to receive further medical intervention at an outpatient clinic or through their primary care medical practitioners.
When symptoms persist or worsen, it is not uncommon for individuals to become worried and return to the emergency department for a re-investigation. This can be due to poorly communicated discharge plans where the individual does not understand the next steps they must take to manage their injury or illness. However, some readmissions are due to the underlying issue not being managed well enough for a safe discharge.
A good way to reduce hospital use after one has already been deemed medically clear for discharge is to receive a written copy of the discharge summary. This will include a brief summary of one’s hospital course, any medication changes, a list of new prescriptions, the plan for medical follow up and scenarios when one should return to the ER for emergency care if certain symptoms develop, persist or worsen. Having a well documented plan can help avoid unwarranted hospital visits while ensuring the health needs of the individual are addressed.
Lack of medical follow up after hospital discharge
Following a hospital discharge, seniors are often instructed to arrange follow up appointments with specialists or their family doctor to re-evaluate their health and treatment plans.
While we all understand the importance of seeing the doctor, many people forget to consider the process involved with going to see the doctor. After a hospital admission, some seniors find it difficult to leave the home to get to an outpatient clinic or the doctor’s office. This may result in delayed assessment and treatment, and may worsen their condition if they do not get follow up.
Things that may make it hard for seniors to attend follow up medical appointments include:
- Nobody to help with transportation to the appointment
- Lack of accessible public transit to reach one’s destination easily
- Low finances to be able to afford a taxi, ridesharing or other transportation service to one’s appointment
- Inability to leave the house related to trouble with stairs and difficulty with walking
- Medical practitioners do not perform home visits or virtual visits by phone or video
Having a good understanding of one’s health conditions and symptoms can help establish a plan of action to address any symptoms or concerns should they arise. Not having the appropriate follow up plan for an illness or injury can provide time for the condition to worsen and for symptoms to become more severe. With this in mind, it is obvious that one’s medical contacts should be regularly updated of any changes to one’s condition.
One strategy to improve a senior’s ability to go to the doctor includes the use of a transport wheelchair to easily move someone from the home to the car and from the car into the doctor’s office. This device is usually used by individuals that have difficulty walking longer distances and it requires a caregiver to push the wheelchair forward.
Difficulty with bathing and personal care
One reason why seniors fail to thrive upon their return home is due to difficulty with having a bath or engaging in their personal care. This may be related to muscle deconditioning where periods of inactivity such as hospital bed rest have led to functional losses in strength or the ability to have a shower and complete activities of daily living.
Many people recover well from a hospital stay when they return home and start to do more personal care activities for themselves without the assistance of hospital staff. This is not without challenges as some individuals feel they need additional help from a caregiver or need to use bathroom safety equipment to make them more safe and as independent as possible when engaging in their personal hygiene.
Decreased strength and walking endurance
Following a hospital admission, it is not uncommon to feel weaker and have less endurance to walk long distances. Mobility aids such as a cane or walker can provide some support for seniors that have trouble with walking, however a strengthening program may be more beneficial if there is any potential of recovering their former capabilities.
Devices like a walker can be used to boost one’s confidence with walking and allow a senior to ambulate greater distances. To use this device within the home, the floor space must be cleared of any clutter and obstacles and ample spacing around frequently used furniture should be given.
Assistive transfer devices such as grab bars and transfer poles can be useful to harness the strength one does have to pull oneself into standing up from a bed, chair, toilet, bath, couch and other surfaces more easily. A pre-discharge home safety assessment can help determine the best equipment to support a senior prior to going getting released from hospital.
When time constraints do not allow for a pre-discharge assessment, the hospital occupational therapist or physical therapist can discuss equipment recommendations to facilitate a safe return home. They are usually able to provide a list of local medical vendors where recommended safety equipment can be obtained either for rental or purchase.
Financial hardship
A hospital admission often leads to new prescription medications and adjustments to existing medications. As well, some conditions leave individuals with a decreased ability to engage in bathing, walking and transfers. To help overcome some of these challenges, assistive aids and transfer devices can be used to improve home safety, make bathing easier and enhance one’s ability to walk.
That said, prescription medication and safety equipment can be expensive and may be a financial burden to some seniors that are already on a fixed income. Pharmacies already assist with this to some degree by providing the option to purchase less expensive generic drugs. For necessary home safety equipment, some senior clubs offer loaner equipment for short periods of time and some charitable organizations offer financing assistance for low income individuals. Depending on the organization, a letter from a therapist or doctor may be required to support a request for funding.
Moreover, being at financial hardship means that someone may be at risk of losing their housing or may already be homeless. Since it is well known that the homeless are high users of the healthcare system, many hospitals have social workers who help patients navigate the healthcare system and apply for subsidized housing. That said, there is often a lengthy waitlist for supportive housing depending on the location and facility.
Brittle or poor support network
As some seniors age, they tend to lose the ability to maintain their own home or care for themselves. Having little or no support from friends, family or neighbours can be one cause of hospital readmissions.
Some scenarios where a support network could provide assistance to a senior recently released from a hospital include:
- Replacing rotten food after a lengthy hospital stay and preparing meals for a senior’s return home
- Helping with transportation to vital medical follow up appointments and tests
- Engaging in tasks that a senior may have difficulty with such as yard work, laundry, and housekeeping
- Advocating for the care needs and concerns of a senior when no-one else will
- Help with descending stairs to leave the home and with car transfers to get in or out of a vehicle
- Organize bills and invoices for automatic withdrawal from the bank to prevent missed payments
Without a support network to manage the care needs of a senior, it is possible for some tasks to be brushed aside and not get addressed. When there is little or no support from informal helpers, assistance from a community based home care agency may be required. Hospitals are often able to arrange this type of support, however it may be associated with a service fee if one’s health insurance does not provide coverage.
Summary
Overall, seniors should focus their energy on recovering from their hospital stay. While that may appear simple, there are multiple factors affiliated with hospital readmissions for the elderly.
Having a good support network to handle some responsibilities is a one way to reduce a senior’s risk of failing to cope at home. Having the financial resources to be able to follow up on medical appointments and obtain necessary home safety equipment is another way to reduce rehospitalizations.
That said, one can have all the resources, personal care support and medical intervention available, but in some cases another admission to hospital is required. The risk of needing emergency medical treatment may always be present for medically complex seniors, but things can be done to reduce this from occurring.