Institute for Healthcare Improvement: Trading Spaces: Remodeling Acute Care for Seniors
By| Wednesday, September 19, 2018
We can probably all agree that no one wants to experience an acute medical event. However, they’re simply a part of life — particularly for seniors who often live with multiple chronic medical conditions, which can, from time-to-time, escalate into an acute situation needing immediate medical attention. Unfortunately, seniors are not only more likely to experience acute medical events, they are also particularly vulnerable when they happen.
The traditional care pathway for acute situations is to call 911, go to the Emergency Department (ED), and then get admitted to the hospital. This traditional care pathway has important and unintended consequences for seniors related to health outcomes, experience of care, and costs.
First, older adults are more likely than non-seniors to be admitted to the hospital through the ED. Once in the hospital, they are particularly susceptible to hospital-acquired infections, delirium, and functional decline, which can lead to extended stays and disposition to skilled nursing facilities (SNFs).
Second, the traditional acute care pathway often leads to a poor experience for seniors. EDs can be overwhelming, complicated, and inhospitable places for everyone, but particularly for older adults. Hospitals are also suboptimal places to spend extended periods of time: patients often don’t sleep well, they lack privacy and familiarity, and often must follow institutional schedules that may be at odds with their normal routines.
Third, ED visits and hospitalizations are expensive. Even with Medicare coverage, seniors pay $1,340 at a minimum for a hospital admission (every 90 days) and they pay copayments and 20 percent coinsurance for ED services and observation stays (when not admitted).
Acute care in the home or SNF-type programs can address some of these problems for older adults by facilitating the delivery of acute care where the patients reside, which is often aligned with their wishes, helps avoid hospital-associated risks, and costs less to deliver.
At the West Health Institute (WHI), our mission is to enable seniors to successfully age in place, with access to high-quality, affordable health and support services that preserve and protect dignity, quality of life, and independence. To that end, we have been working closely with the Institute for Healthcare Improvement (IHI) to remodel the care seniors receive when they experience certain acute medical events to, in effect, trade the original “space” for treating these events (the hospital) for a new space (a senior’s home or SNF).