Something’s rotten in care of the elderly – what does this week’s KHN tell us?

Do hospitals mismanage support for vulnerable older adults?  And we wonder why people, including doctors, avoid hospitals. We knew that an older adult going into the hospital experiences or departs with an unwanted side effect. Half a million per year acquire C.Difficile in hospitals -- costing $4.8 billion; ICU risk of death is 35% higher for elderly. And MRSA has a 12-month death rate of between 20 and 35% -- with the most vulnerable, you guessed it, the elderly.  But did you know that one-third of hospital patients over age 70 and half of the patients leave the hospital more disabled than when they arrived?  Question raised: what about appointed or actual advocates when elderly patients are admitted – is someone present or appointed by the hospital who will observe care, including vigilance about hand-washing or ICU treatment– perhaps the state-by-state Care Act address this in a future update.

In another one of those meaning-reversed headlines, consider dementia and abuse.  Yet another lookback study and a headline problem: So either assisted living residents with dementia are prone to abusing others (including staff) – or the interesting reversal – residents who abuse other residents in assisted living are likely to have dementia or mental illness. And from the text: “Elderly people often enter assisted living when disabilities and illnesses compromise their ability to live alone safely. Once they enter a facility, cognitive impairment, behavioral issues or physical limitations can leave them vulnerable to mistreatment.” Note: according to the Alzheimer’s Association, more than 50% of residents in assisted living have some sort of dementia.  Question raised: when staff sees an incident of abuse, what is the specific course of action to prevent recurrence, including specific treatment of abuser or separation by location?

The readmission penalty is not preventing readmissions of the elderly. Does this make sense? First CMS creates a penalty for readmitting a patient within a fixed time period, then raises the penalty in an apparent hope this would create some new treatment behavior to prevent readmission.  Initially that might have included follow-up phone calls, visits from a nurse, and even hope for some telehealth oversight of the patient.  Well, that didn’t work. More than half of US hospitals (2597) are receiving the maximum penalty for readmitting patients who have had heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements. Questions raised: Besides the fact that the entire state of Maryland was exempted from penalties (??), why does this process ignore whether a hospital than the average share of elderly and vulnerable patients?

Seeing tech where there may not be a possibility – or missing the possibilities.  Hospitals may have access to an online roster of paid advocates (some paid by them) overseeing care. The advocates could fill in at admission time if no family member were available. Imagine if assisted living communities had enough staff or cultivated a well-trained volunteer network that could watch for residents prone to abusing others.  And finally, what is the step-by-step process post discharge, augmented with appropriate tools, including automated check-in calls, post-discharge apps if feasible, remote visitations if Internet is available or data mining and predictive analytics  to avoid the readmission of elderly patients?