In-home primary care for the elderly one way to prevent hospitalizations

August 22, 2016
Home-based primary medical care for elders who are chronically ill and frail reduces emergency departments visits and hospitalizations.

Home-based primary medical care for elders who are chronically ill and frail reduces emergency department visits and hospitalizations.

In the recent Kaiser Heath News article entitled “Elderly Hospital Patients Arrive Sick, Often Leave Disabled” writer Anna Gorman paints a very bleak picture of the state of elderly care in hospitals around the U.S. Gorman cites research that shows about one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived.

The reasons are plentiful, Gorman contends. The short list is that elderly patients aren’t fed properly, gotten out of bed enough and that their pain is not controlled. When you add that many times they are subjected to unnecessary procedures, prescribed redundant or potentially harmful medications and aren’t afforded the proper environment to sleep, it is no wonder she says that older patients struggle with regaining the person they were physically, emotionally and cognitively prior to their hospitalization. 

Chronic conditions worsen the longer the stay

“Hospitals were not designed for treating elderly people. Their job is to treat acute medical conditions; essentially, “fix” the problem, then discharge them back home,” says Housecall Providers geriatric nurse practitioner Amy Long. “The issue is that elderly people many times have chronic medical conditions in addition to the acute issue that’s landed them in the hospital and those can get exacerbated the longer the stay.”

The home-based medical organization Housecall Providers has long maintained that in-home primary medical care to the chronically ill lessens their need for emergency and hospital room visits, albeit not for acute cases like heart attacks, strokes, or broken bones. But, because primary care providers (PCPs) visit patients in their homes, they are able to identify hidden dangers to an already frail body like loose rugs or cords that could pose a serious fall risk.

In-home primary care helps patients find and stay in equilibrium

Housecall Providers PCPs provide another valuable service to their patients (median age 84), in that they monitor and manage the homebound elders’ chronic conditions so that they can find and stay in equilibrium to optimize their function and comfort. Delivering this managed care in the comfort of a patient’s home has enabled the organization to reduce the need for emergency department visits and hospitalizations for its patients. In 2015, the nonprofit experienced a 10% 30-day hospital readmission rate for some of the sickest Medicare beneficiaries, while the Medicare average in Oregon for all patients 65+ is 16%.

“As someone ages, their equilibrium becomes more and more precarious and fragile. Putting someone in the hospital takes them out of balance and it can take days, weeks, months to get them back there, sometimes they never make it,” Long said. 

Hospitals aren’t liable if patients lose their memories or their ability to walk during their stay. Where they do shoulder a financial burden is if patients fall, get preventable infections or return to the hospital within 30 days of their discharge. It makes sense then that administrators and staff would focus on keeping the patient “safe”, instead of using additional resources to address the needs of this population.

Fewer penalties add up nonetheless and translate to expenditures, not for the hospitals, but certainly Medicare. Although impairment and functionality usually aren’t measured in the hospital setting and only occasionally researched, a report in 2010 by the Department of Health and Human Services Office of Inspector General found more than a quarter of hospitalized Medicare beneficiaries had suffered an “adverse event,” or harm as a result of medical care, which ended up costing Medicare $4.4 billion annually. Doctors who reviewed the incidents, such as bed sores or oxygen deficiency determined that 44% of those cases could have been prevented. Nearly $2 billion dollars was spent on incidents that should have never have happened in the first place.

Acute Care for Elder (ACE) units save $1,000 per patient visit

The medical community has long known that hospitals are not delivering elder care at the quality necessary to prevent mental or physical deterioration. Over the last two decades, Acute Care for Elders (ACE) units have been developed in hospitals nationwide. While the units are still rare – there are only about 200 around the country, they have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. A Health Affairs study in 2012 revealed that hospital units for the elderly saved about $1,000 per patient visit.

An in-home primary care provider for over six years, Long has her own prescription for helping her patients stay out of the hospital. “I get to know my patients well enough to get them into equilibrium and then when I recognize they are slipping out of it, I manage their care to help them restore it,” she said.


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