VENUES OF POST-HOSPITAL CARE. Or “Where, Oh Where Will My Patient Go Next”?. Ed Vandenberg MD CMD Bill Lyons, M.D. UNMC Geriatrics & Gerontology. Objectives . Upon completion the learner will be able to :
“Where, Oh Where Will My Patient Go Next”?
Ed Vandenberg MD CMD
Bill Lyons, M.D.
UNMC Geriatrics & Gerontology
Upon completion the learner will be able to :
consenting patients whose medical needs can be safely managed at home when:
The required time, financial, physical and emotionalresources have been considered.
reasonable and necessary” for the treatment of an illness and injury”
Requires Skilled Services
HOME BOUNDHome with Home Health Care
Services that are:
Other services may be added only if one of the 3 above skilledservicesare needed
-Home health aide
Leaving home requires considerable and taxing effort.
Note: the HOMEBOUND can leave home if:
*Infrequent is often interpreted as once a week for non-medical outings)
Medicare pays for:
Konetzka, et al. 2006
Services that SNFs might provide: (not required)
- Physician first visit within 30 days admit
- Physician/Mid-level alternate every 30 d x 3 then every 60 d.
Examples; Immanuel, Madonna
is the patient reasonably expected to improve
For: Medically complex
Where in Omaha: “Select Hospital” “Select Hospital” (located near Bergan Mercy Hospital)
Examples Patient Types:
Long term ventilators
Long term parenteral antibiotics
Extensive decubitus or wound care
Negative air flow room needs
Multiple IV medications
Combinations of > 4 treatments (e.g. Nebs, IV’s , wound care,)
Bottom line: Ask to see if person qualifies
Attendings: LTACH has list of physicians.
Default (problems exceed home care, and does not qualify for any preceding venues of care)
Private or Medicaid or long-term care insurance
such as a hospital bed, commode, special wheelchair, and other special assistive devices.
Home with Home Health Care 4.3%
Acute Rehabilitation 1.7%
Long Term Acute Care Hospital 0.2%
SNF (Medicare covered)- 23.2%
Nursing home care( non Medicare covered)
3.5%At time of admission to hospital your elderly patient faces discharge to one of the following:
Review strategies and techniques to ensure timely and appropriate discharge.
-Complications of hospitalization
-Physician's “over estimation” of patients recovery abilities.
-Patient/family “unrealistic” expectations of recovery speed and level.
-“Last minute” planning
On or soon after admission:
Reduce “overestimation” errors by:
“Oh 2 –3 days”
Does not account for post op complications or variations in patient response
“everyone is different but here are the things you will have to be able to do before you leave”.
#1 Medical &/or Surgical problems Stabilized
#2 ADL’s appropriate for discharge dispositionDefine discharge by Goals rather that Time
Lack of knowledge of:
-Pt’s third party payer
-Family and resources
Inadequate discussion of discharge planning
Early SW involvement
Early SW involvement
Disposition discussions by physicianReasons & Remedies for Delays in:Discharge per Social Work
-Assist with coordination care.
-Knows the local systems & family better
-Knows the patient and can advise the patient/family on appropriate placement
Patient/family “unrealistic” expectations of recovery speed and level.
“Last minute” planning
Realistic expectations (add ADL’s to DC planning )
Introduce reasonable alternatives early
Involve SW & PCP earlyReview