Hospitals-Not for the Elderly?

You’ve likely heard some variation of the phrase that hospitals are no place for sick people (indicating you can’t get rest in a hospital with all the comings and goings that go along with a hospital stay). So consider this article that ran in the December issue of  The Atlantic, The Hospital Is No Place for the Elderly. The focus of the article is what the author refers to as “late-life care.”

For years, many people in medicine have understood that late-life care for the chronically sick is not only expensive but also, much too often, ineffective and inhumane. For years, the system seemed impervious to change. Recently, however, health-care providers have begun to realize that the status quo is what Stuart calls a “burning platform”: a system that is too expensive and inefficient to hold. As a result, new home-based programs are finally reaching the market….

The article discusses the advantages of in-home care and notes the myriad choices for this type of care.  Sutter Health, out of California, offers a program,  “Advanced Illness Management” (or AIM) where “each patient is assigned to a team of nurses, social workers, physical and occupational therapists, and others. The group works under the direction of a primary-care physician, and meets weekly to discuss patient and family problems—anything from a stroke or depression to an unexplained turn for the worse or an unsafe home.” The focus of the team is the goals of the patient.

The article also discusses how Medicare pays for certain types of health care (hospitalization, for example) but not others and reviews several different programs.

The article tackles the “why now” questions (I don’t think it would be a surprise to us that people prefer to have care in their homes rather than in hospitals or nursing homes). The article offers the following explanation: the Affordable Care Act…

Medicare has begun using its financial clout to penalize hospitals that frequently readmit patients…. earmarked money [is] specifically to test new care models, including home-based primary care.  Perhaps most important, [the ACA] is changing the business calculus by creating alternatives to fee-for-service payment. It is beginning to set up new provider networks and payment schemes that let health systems and insurers share in what they can save by preventing unneeded treatment (while also requiring them to shoulder some of the risk of cost overruns).

The author cautions that this, like most change, will take time, especially since we are dealing with a large bureaucracy (Medicare) and all the players will have to readjust their perspectives: doctors won’t always be the quarterback, but will be part of a team.  Nurses need to consider “hospitalization as a last rather than a first resort.”  Patients, too, need to change their views of their care, and understand that home care may be at least as good, if not better, than a hospitalization,