A recent study by the Foundation for Healthy Communities found frequent delays in hospital discharges for medically cleared patients in New Hampshire. Data collected from 21 acute care hospitals in the state revealed that over half of affected patients were over the age of 65.
The biggest barrier to timely discharge was access to a nursing home bed. Other barriers included insurance and Medicaid issues and the sometimes lengthy process of establishing a guardian for older patients. Mental health is often a barrier as well. The study found an average discharge delay of 20 days - though there are some mentally ill patients that can remain in hospital beds for over 50 days.
These stays add up - the Foundation estimates that an additional $27 million dollars in expenses were accrued over just three months by people staying in acute care who did not have acute care needs.
Though there are state and local programs in place to address the needs of these patients, immediate access to them can be difficult without advanced planning or insurance coverage. A cohesive effort among individuals, families and long-term care providers, suggests Sean LaFrance, Executive Director of the Foundation, may be necessary to combat the costly acute care limbo.
RICK GANLEY, HOST: This is Morning Edition on NHPR. For some Granite Staters it can take weeks to be discharged from the hospital, even after being medically cleared. That’s according to a new study which also found older patients are most likely to run into barriers to a timely discharge. Sean LaFrance is Executive Director of Foundation for Healthy Communities and he was the author of that study. He joins us now – Good Morning Sean.
SEAN LAFRANCE : Good morning.
GANLEY: Sean, your survey identified more than 500 patients who had to stay in the hospital after being medically cleared. Now, what did you find?
LAFRANCE: We found that [a] significant number of people are unable to leave the hospital when they’re ready because of a variety of barriers. And mostly these have to do with where someone’s going to live – some type of nursing home care, and/or some people who have a home they could go back to but they need support to remain in their home – and how that is provided and paid for is a challenge.
GANLEY: So this can involve a lot of logistics, it’s a lot of talking to different agencies, getting different agencies to talk to each other, and it takes a lot of time, a lot of effort, a lot of cost.
LAFRANCE: Yes and so it is expensive. I mean, we did look at the total number of days that these 516 people represented and that’s over 10,000 days and that 2,600 dollars a day, that’s over 27,000,00 dollars in cost attributed to an acute care setting that probably could be their care could be provided at much lower cost if we could make the system work more smoothly.
GANLEY: Somehow streamline this.
GANLEY: Your study identified lack of housing and in-home care as some of the major barriers, but you also looked at being able to access mental health care – what other kinds of barriers did you find?
LAFRANCE: We have a problem in terms of long term care facilities that are staffed and set up to care for people with dementia, Alzheimer’s and psychiatric issues. The state has the one facility at Glencliff and many people die waiting to get on the waiting list to get to a place like Glencliff.
GANLEY: Uh, What about complications around health insurance?
FAFRANCE: Well health insurance, while we’ve had this great expansion if you will under the health reform law and with the New Hampshire Health Protection Program, that is mostly health insurance that deals for most of us when we’re younger or working and such. Uh, it doesn’t pay for long term care, if you will.
GANLEY: Given all of this and what you’ve talked about, does the study make any recommendations?
LAFRANCE: We do not. It’s actually much more of a documentation of a problem. And so the purpose of this was to sort of try to document the extent of the issues and the scope of the problem, if you will, and now meet and start talking with people. I mean, we’ve had initial conversations. I mean, the healthcare system – we call it a healthcare system – but obviously, you know, there’s a tradition of - hospitals work together and the state has its programs, the nursing homes and long term care folks are in their particular orbit. But this is not a systems approach. This is sort of happening. I think this points to the need for much better communication, much better integration across acute long term care, home care and then the various public agencies that are helping to facilitate payment and coverage for some of these.
GANLEY: You’re shining a light on a very complicated issue.
LAFRANCE: Right. But we have to remember it’s an individual at the center of what we’re talking about. And while these are complex, we have to sort of keep the person in the middle and start to figure out maybe simpler systems that meet people’s needs versus some of the overly complex approaches that we might have now.
GANLEY: Sean LaFrance is Executive Director for Foundation for Health Communities. Thanks so much for coming in.
LAFRANCE: Thank you.