Richard, age 67, was hospitalized because of severe cellulitis in his left leg. He is homeless, which makes it challenging to keep his leg clean and manage the swelling and sores. He was discharged from the hospital with many resources available to him, just to return to the hospital the following day because of increased pain.
Louise, age 89, lives in an assisted living facility and was hospitalized because of pain after falling in her apartment. She was discharged from the hospital on Thursday, came back to the hospital on Friday because of uncontrolled pain and returned to her assisted-living apartment that same day. Louise arrived at the emergency department again on Saturday for pain, just to be discharged on Sunday when minimal staff is present at the assisted-living facility.
Richard and Louise are just two out of many seniors who unnecessarily cycle through the hospital system. This can be avoided by providing timely and quality access to outpatient care; improving medication management; promoting education on navigating the health-care system; integrating coordination of care across multiple systems; and enhancing communication between providers, patients, and their family caregivers.
Especially stressful for older patients
According to a recent study, hospitalizations can be especially stressful for older adults who are at increased risk of developing hospital-induced delirium, communicable diseases, and increased frailty at discharge. According to the Minnesota Department of Health (MDH) [PDF], approximately 84 percent of Medicare enrollees are 65 years of age or older, account for 30 percent of all potentially avoidable hospitalizations, yet contribute just under half (42 percent) of Minnesota’s health-care spending. Older adults account for the minority number of potentially avoidable hospitalizations, yet cost more than individuals under the age of 65.
It is important to understand the underlying issues and reasons for potentially avoidable hospitalizations in order to seek solutions.
First, the rapid aging of our population places pressure on the health-care delivery system and health-care spending. According to the Facing Aging Campaign and the Minnesota State Demographic Center, at least 60,000 Minnesotans will turn 65 every year, now through 2030; an increase of 285,000 people during the 2010 decade, which is greater than the past four decades combined. As we approach the 2020 decade, another 335,000 Minnesotans will turn 65. With the complexity of care older adults need, it can be anticipated that the amount spent on health care will increase as more people age.
Second, as people get older, they are more likely to develop a chronic condition. According to a Minnesota Department of Health (MDH) report [PDF], 72 percent of Minnesotans age 65+ had at least one chronic condition. One chronic condition costs approximately $12,800 per year to manage and an extra $6,000 per year for each additional chronic condition.
Finally, the MDH study on chronic conditions discusses how the social and economic determinants of health such as income, education, and healthy and safe housing directly impact an individual’s health status. When these conditions are poor, people are at greater risk for needing more intensive health-care services. People of color and American Indians are disproportionately represented within disadvantaged socioeconomic groups, putting them at greater risk for potentially avoidable hospitalizations.
With hospitals at the center of our health-care system, there is an inward focus of one part of health care instead of the entire system. With a shortage of primary care physicians, it is challenging to get same-day appointments with a physician to get quality, timely care, making hospital utilization preferable among low-socioeconomic patients due to perceived convenience and quality.
A model that works
The Health Care Home model [PDF], one of the key pieces to Minnesota’s health-care reform policies in 2008, involves nurses and care coordinators to be available for questions between physician visits. Utilizing nonphysician professionals to address questions and concerns increases accessibility to more comprehensive primary care services. This model has been shown to reduce hospitalizations, improve management of chronic conditions, and save up to $1 billion over a five-year period in health-care spending. Approximately 54 percent of Minnesota clinics are certified as a health-care home. Rural clinics are in dire need of health-care-home access; 32 counties in rural Minnesota lack access to a health-care-home clinic. This results in approximately 500,000 people who do not have access to this quality care.
Health Care Homes have shown to reduce hospitalizations by 40 percent; inpatient hospital costs by 30 percent; length of hospital stays by 20 percent; and outpatient hospital services by 8 percent. Considering these results, it is recommended that all primary care providers offer the Health Care Home model so all Minnesotans can experience timely, quality care to live a healthier, more satisfying life.
Sarah Lahr has worked over the past 10 years as a licensed social worker working with the aging population and their family caregivers for Augustana Care Corporation, United Hospital through Allina Health, and Care Coordinator for the Wilder Foundation’s Caregiver Services Program. She is in the Masters of Public Health Administration & Policy program at the University of Minnesota studying the integration of the health care system and home & community-based services to support older adults and their caregivers in their communities.
 Figure calculated by writer. Figures found by dividing Medicare PPE by total PPE.
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