Be Your Own Patient Advocate (Video)
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Discharge From Hospital to Skilled Nursing Can Have Long-Term Consequences
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A national study has shown that being hospitalized for a stroke or hip fracture can lead to long-term institutionalization in a nursing home. Direct discharge to a skilled nursing facility put patients at “extremely high risk” of needing long-term nursing home care.
Researchers at the University of Texas Medical Branch in Galveston suggest that programs aimed at helping older patients recuperate successfully at home instead of in an institutional setting could greatly improve their health outcomes and reduce healthcare costs.æ
Lead author James S. Goodwin, MD, Director, Sealy Center on Aging at UTMB noted that certain factors common among the elderly — cognition problems, frailty, lack of social support — increase the risk of nursing home institutionalization.
Goodwin and his colleagues measured a five percent sample of Medicare enrollees (approximately 762,000) aged 66 or older between 1996 and 2008 who were admitted to nursing homes. Of that population, 75 percent were admitted to a nursing home for long-term care within six months of a hospital stay.
This correlated to Medicare’s adoption of a prospective payment system that encouraged hospitals to reduce the length of stays.
Researchers also found several factors that reduced the risk of long-term institutionalization. Patients cared for in larger hospitals and major teaching hospitals were less likely to be in a nursing home six months after discharge, as were patients treated by their primary care physicians.æ
Goodwin recommends that hospitals consider alternatives to skilled nursing facilities post-hospitalization, such as community-based facilities, assisted living facilities and at-home care.
And that is a lesson for us. Understand what the discharge options are for your hospital and consider a hospital that offers options for rehabilitating at home.
Being Your Own Patient Advocate
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Joe and Teresa Graedon’s book “Top Screwups Doctors Make and How to Avoid Them” is an acknowledgment that serious mistakes are made at every hospital in America on a daily basis. Its genesis started with their own nightmare involving Joe’s mother’s care in an NC hospital.
The Graedon’s book contains more than a dozen lists to help patients and families get the best care. It includes:
- Lists of common mistakes made in hospitals or by doctors and pharmacists.
æ - Lists of tips to prevent medical errors, dangerous drug interactions and diagnostic disasters.
æ - Suggestions to promote good communication and survive old age.
Here is some advice:
- Expect mistakes and have an advocate.
æ - Check every medicine. Make sure the dose is right.
æ - Be assertive
- Demand an explanation.
æ - Be vigilant during transitions, from one floor to another, or when shifts change.
- Alert the nurse or “rapid response
team ,” if something seems wrong.
æ - Obtain detailed discharge instructions and contact information. Know what symptoms might signal a worsening situation or infection.
æ - Hospital doctors may never speak to your primary care physician. Take your records and don’t assume doctors already know what’s in them.
æ - Double-check everything. Don’t assume no news is good news or that test results are always correct.
æ - Take a friend or family member to doctor’s visits. Nearly every error made in the hospital can also be made in the outpatient setting.
