Reduced Readmissions: Creating Smooth Transitions from Hospital to Home posted on: 03-06-2014

Thanks to recent healthcare reform regulations, hospitals today are under increased pressure to reduce patient readmissions in order to avoid costly fines. It’s a big battle to fight, considering that nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days, translating to approximately 2.6 million seniors at a cost of over $26 billion every year. Readmission rates are also high for patients covered by Medicaid and private insurance.

The main culprit behind preventable hospital readmissions is the lack of communication and coordination that takes place when patients transition from hospital to home. In general, the standard of care has been to give patients discharge instructions and have them assume responsibility to fulfill the plan. The problem with that standard is that:

  • Some patients do not receive adequate education about their discharge plan.
  • Many are unable to understand or follow the plan.
  • Family members may provide little to no support, and basic needs may not be met.

So how can we create smoother care transitions and keep patients out of the hospital?

  • Ask questions: Patients cannot assume that they have everything they need when they are being discharged from the hospital. Ask questions like:
    • Where will I get care after discharge?
    • What are specific problems to watch for?
    • What should I do if these problems arise?
    • Will I be able to: Bathe? Climb stairs? Drive? etc. upon returning home?
    • Would having the help of a home care agency be beneficial?
  • Understand your care plan: Doctors are busy, and they often rush through the patient’s plan of care during the discharge process. Make sure you understand your or your loved one’s diagnosis and care plan before leaving the hospital. This includes what medications are necessary, instructions for taking medications, level of activity that is recommended, etc.
  • Work with a qualified home care agency, like North River Home Care: Our caregivers are trained to notice symptoms that may lead to complications and can contact the client’s physician to ensure that proper care is taken before a complication arises. We can also monitor the client’s care, including his or her diet and activity levels, ensuring medications are taken as prescribed and that the physician’s plan of care is being implemented.

Hospital readmissions aren’t just costly for the hospital; they’re financially and physically taxing on the patient as well. Let North River Home Care of Norwell, Massachusetts provide a smooth transition for your loved one and avoid unnecessary rehospitalizations. Contact us today to learn more about our in-home care services.