Choosing The Right Assisted Living Option May Reduce Hospital Readmission Rates For High Risk Elderly Clients
(May 2014 Gilbert, AZ) CarePatrol Chief Executive Officer, Chuck Bongiovanni was invited to speak in this summer’s Southern California National Readmission Prevention Collaborative Conference to discuss “How Choosing The Right Assisted Living Option Can Reduce Hospital Readmission” . Multiple studies indicate that approximately 20% of Medicare patients are readmitted to a hospital within one month of discharge. The Center for Medicare & Medicaid Services (CMS) has found this number to be excessive. Many argue that the quality of care provided is not adequate for persons in one particular group. In fact, much of hospital spending and readmissions is for a small percentage of high-cost Medicare beneficiaries who tend to be older and have multiple chronic conditions.
A 2013 study sponsored by CarePatrol produced a 45% reduction in readmission rates for this elderly group simply by placing the patients in the proper care environment; Assisted Living Facilities (ALFs) that have the operational capability to properly care for the elderly patients’ broad range of chronic conditions.
Why was such a significant reduction possible? According to a published Dartmouth study, the top five reasons for hospital readmissions were:
1) Patients and their families (Patients) may not fully understanding their diagnosis and treatment
2) Patients being confused over medication instructions
3) Hospitals Discharge Planners not providing patients with follow-up information or test results
4) Patients not scheduling a follow-up appointment with their doctor
5) Family members lack of knowledge to provide adequate care
There are limited published transitional care modalities that place any emphasis on ALFs as a viable deterrent to hospital readmissions. However, each of the top five reasons for readmissions can be avoided by the use of ALFs in the continuum of care.
During the past few years, ALFs have become increasingly adept at effectively supporting the health and well-being of high-acuity patients; caring for elderly residents with multiple chronic conditions. As a result, hospital social workers and discharge planners must reevaluate their discharge options so as to recognize the viability of ALFs for elderly patients with one or more chronic conditions.
WHY MUST ASSISTED LIVING FACILITIES BE AN
INTEGRAL OPTION IN THE CONTINUUM OF CARE
As little as 10 years ago, the average ALF resident was 74 years of age with the need of some ADL assistance (see Exhibit 1). This has drastically changed. According to the National Center For Assisted Living, the typical resident is now a woman about 87 years old who needs assistance with approximately two to three activities of daily living (ADLs). Additionally, she will have two to three of the Top 10 chronic conditions (See Exhibit 2).
ADL % of Residents Needing Assistance
Top Ten Chronic Conditions
Multiple Chronic Conditions75%
High Blood Pressure:57%
COPD and allied conditions:15%
Because proper diet and accurate medication management are extremely important factor in reducing readmissions, it is important to note that eighty-seven percent of ALF residents need and receive professional help with nutritional planning and meal preparation, while 81 percent receive professional oversight managing their medications.
When required, Medicare Home Health services, including skilled nursing visits, physical therapists, and other licensed professional services can be performed in ALFs as well as smaller residential Board and Care Homes.
The trend towards long-term support of higher acuity patients/residents in ALFs is being met with higher levels of skilled staffing. Silverado Senior Care, for example, recently reported that in many of their ALFs they offer more actual nursing hours per day per person than most Skilled Nursing Facilities.
ASSISTED LIVING FACILITY REFERRAL:
CURRENT HOSPITAL METHODS
Hospital Social Workers and Discharge Planners have ever increasing caseloads and responsibilities. Because of this, it is impossible for them to fully “know” the quality of care delivery in the every increasing number of local ALFs and residential Board and Care Homes.
Care Violation History
Range of Chronic Conditions Supported
Care Environment and Settings
Room and Board Costs
With limitations to and legality of “recommending” an ALF, local hospitals tend to simply hand the family a “list” of ALFs that are available in the area for the family to begin what is inherently a complex and time consuming search on their own.
This creates a problem in and of itself. Equipped with only a list and limited time, families, that are already under multiple physical, emotional, and mental stresses, tend to choose ALFs for the wrong reasons. Attractive lobbies and a friendly greeter determine the facility chosen, not facts concerning the ALF’s expertise caring for residents with the specific chronic conditions of the patient being discharged.
At the end of the day, when the discharge process of the hospital only provides the family with a list of assisted living facilities, the family is likely to choose a facility based on appearance. Leaving the family to evaluate a “list” on their own will lead to preventable hospital readmissions.
THE CAREPATROL MODEL
By integrating CarePatrol into the discharge process, instead of simply providing a list, hospitals are able to avoid the preventable hospital readmissions of elderly patients with one or more chronic conditions. CarePatrol perfected a social work model to help families find appropriate & safer assisted living options specifically tailored to meet the individual needs of a post-acute hospitalized patient.
The CarePatrol model consists of four (4) foundational points of success:
1) The Care Discovery
2) The Provider Profile
3) The Personal Tour
Referrals from CarePatrol’s hospital partners are received and managed by a centrally located staff of Social Workers who assign a local Certified Senior Advisors (CSA) to each case. The CSA personally meets with the family, discharge planner/social worker, and the patient to complete a Care Discovery. A Care Discovery is specific level of care evaluation of the patient that includes the hospital discharge instructions, the patient’s ADL needs, financial resources, and personal preferences.
Once this critical information is collected, the Care Advisor will “match” the patient with 3 to 4 ALFs and schedule a tour of each ALF with the family. It is important to note that all ALFs in the CarePatrol Network are pre-screened and their care and violation histories are previewed by Certified Senior Advisors.
During the tour, the Care Advisor is there for guidance, support, and to ask the myriad of highly relevant questions that the family is not equipped or prepared to ask. Once the tour of the ALFs is completed the Care Advisor helps the family to objectively and successfully navigate the ALF selection process.
Once a client moves into an ALF or residential Board and Care Home, CarePatrol schedules an independent nurse to evaluate the patient, to verify the prescribed care is being provided, and to be a proactive agent to deter hospital readmissions due to pneumonia, for example.
Scheduled follow-up by the Certified Senior Care Advisor will occur frequently over the next few months and then taper off over the next year – minimizing longer-term readmissions.
This service is provided at no additional cost to the hospital or the patient as it is paid for by the thousands of ALFs and residential Board and Care Homes in the CarePatrol network.
Having the right care environment is imperative in reducing hospital readmissions for elderly patients with multiple chronic conditions.
Unfortunately, due to numerous factors, a transition to the patient’s home environment is often the first step in the readmission cycle. The home care environment may lack required:
Families searching on their own from a list of ALFs lack the expertise and information to adequately “match” their loved ones’ specific and unique care needs with the ability of an ALF to fulfill those needs.
CarePatrol serves as that expertise and information source. CarePatrol provides the patient and their family multiple qualified ALF options ensuring the patient’s right to choose is protected and the likelihood they will be readmitted measurably reduced.