Senior Medicare Patients Return to the Hospital After Discharge

HEALTH in NY TIMES     | December 08, 2009
Groups Try Simple Steps to Avoid Hospital Rebound
WASHINGTON (AP) — Talk about unnecessary misery: One in five Medicare patients winds up back in the hospital within a month — even worse, one in four patients with heart failure.  Read more @ the NY Times.

My Thoughts on this Article.

If we had not experienced this phenomenon in our family — more than once — it would be difficult to believe. In fact we’ve been through it multiple times.  Care transitions are exactly what we need.

A family member checks out of the hospital and something does not seem quite right. A call is made to the doctor’s office for help, but is not returned for a long time.

Or one of our parents does not feel well, visits the doctor, and and a condition is diagnosed or identified as a possibility. Tests are scheduled, but the person feels worse or has significant questions, calls the doctor, and cannot seem to get through the receptionist to communicate with the doctor (or sometimes even a nurse).

Twice this year a doctor has discharged one of our parents from the hospital. On each occasion the doctor told the parent to schedule an appointment in one week. We went home, called the office immediately (within two hours) and were told that the only appointment was in two or three weeks. We scheduled, hung up the phone and tried to figure out what to do.

We asked ourselves. Should we call back and insist? Did the doc not really mean one week? Was he/she just tossing off a hypothetical time? What will happen if we don’t go in one week?  In one of our situations, following a heart procedure, our understanding was critical.

None of our parents exaggerate. In fact, if they are in pain they don’t complain that much. For them, the comment on a doctor’s answering machine that tells them call 911 in a true emergency means that they are either writhing in pain or passed out, not that they are short of breath (which could well precede a 911 type of issue).

As the article points out, current senior parents are respectful and considerate and do not want to bother their physicians. Moreover, if they leave a message, they may tend to wait around for a call back (Doesn’t everyone get a timely call back when they leave a message?). This is a generational issue –today’s seniors were trained to return messages in a timely and polite manner.

I do not want to appear to rant about bad nurses and doctors, who I believe are dedicated professionals,  or even doctors’ office staff members. And I applaud the innovations that practices and hospitals are developing to help solve problems experienced by Medicare patients.  However, there is something structurally wrong with the system when the doctor gives specific instructions to a patient, and the patient cannot follow those instructions because someone in the doctor’s office tells them so. It feels like relatively small steps can be taken in any office to solve the problem.

I want my parents to stay healthy and to get healthy when they are sick. However, we need the system to system to work during those in-between health moments when they need the support and are trying to be proactive, preferably without me or my husband intervening (because no parents want their adult kids to intervene unless it is absolutely  necessary).

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