Case in Point features Dr. Eric Rackow's expert perspectives on care transitions and the importance of addressing functional needs

Case In Point - March 9, 2011 - An alarming rate of one in five seniors is rehospitalized within 30 days of being discharged from a hospital. Only half recall receiving self-care instructions or seeing a doctor the month after they leave the hospital, suggesting that a substantial number of hospitalizations could be prevented with adequate discharge planning, education and follow up.

Considering the prevalence of chronic conditions and functional limitations among our elderly, it's no surprise that Medicare beneficiaries 65 years and older account for 12 percent of the U.S. population but more than one-third of hospitalizations and almost half of total hospital costs.

Emergency room visits and hospital admissions are failures of the healthcare system to provide timely, effective care. The problem stems from our healthcare system's focus on disease management and a lack of attention to the reality that activity limitation is an independent risk factor for increased healthcare costs.

In fact, according to a LewinGroup analysis of Medical Expenditures published in 2010, seniors with multiple chronic conditions who received help with instrumental activities of daily living (IADL) and activities of daily living (ADL) were seven times more likely to be among the top 5 percent of patients most expensive to treat - more than twice the rate of those with multiple chronic conditions alone.

Chan et al. reported in the Archives of Physical Medicine and Rehabilitation in 2002 that these increases in cost are attributed to an increase in the frequency of all events (e.g., hospital admissions, outpatient visits) rather than an increase in the intensity or cost of those events.

It is now recognized that when patients with complicated medical, functional and cognitive conditions receive care coordination in the home by specially trained geriatric care managers, hospitalizations and emergency room admissions are substantially reduced. In fact, SeniorBridge's data show 90 percent fewer emergency room admissions, 80 percent fewer hospitalizations and 70 percent fewer rehospitalizations within 30 days in older adults receiving care management in the home.

As an industry we must identify patients with these functional limitations as at risk of a rehospitalization and ensure they have the proper support system that goes beyond medical needs to address physical and cognitive function that puts them at risk for adverse events. Does the patient have food in the refrigerator to ensure adequate nutrition and hydration? Is the patient taking medications or vitamins you don't know about? Are their support limitations preventing them from complying with a discharge plan?

Disease management is only part of the problem. Until we address these functional needs, we cannot provide these patients the care they deserve. Dr. Eric C. Rackow is President and CEO of SeniorBridge, a national health management company that provides care management and direct care in the home, and is a Professor of Medicine at NYU School of Medicine.

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