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Throughout the state of New Hampshire there are 26 hospitals offering comprehensive services and quality care to its patients, many of which have achieved national recognition for their quality of care. From the northern tip to southern New Hampshire, these hospitals continually work to develop and utilize new technologies to increase and improve health care options.The Dartmouth-Hitchcock Medical Center in Lebanon has made it to the list of “America’s Best Hospitals” for its specialized excellence in research, diagnosis, treatment and education. Throughout the state there are Dartmouth-Hitchcock branches in locations including Concord, Keene, Manchester, Bedford and Nashua.Located in the Queen city is the Elliot Hospital and the Catholic Medical Center, both which offer urgent care facilities. Also in Manchester is the Manchester VA Medical Center offering various services to veterans including urgent care, primary care and long-term care.The Speare Memorial Hospital located between the Lakes Region and the White Mountain National Forest in Plymouth offers a wide variety of health services. With recent expansion, Speare has made additions to better meet the needs of its patients living or traveling in the northern part of the state.The Frisbie Memorial Hospital in Rochester has been providing high quality care for over 80 years while keeping up with latest technologies to meet the ever changing health care needs. They have specifically received recognition for the Joslin Diabetes Center Affiliate located within Frisbie Memorial and offering high quality education to patients with diabetes.Despite the great need for high-quality care, Frisbie Memorial Hospital, among others, has faced the crunch in the recession where hours were cut for more than 100 employees and over 20 workers lost their jobs, back in 2009’s recession.The St. Joseph Hospital in Nashua is a full-service healthcare system working to meet its patients’ needs through innovation, technology and great quality care. Their main campus is leading the way in prevention, diagnosis and treatment of disease. They also have a rehabilitation center and childbirth center.The Concord Hospital, located in southern New Hampshire has received great recognition for their specialty in orthopedics, and also provides support in urologic care, women’s care, cancer care and cardiac care. According to a press release by the Concord Hospital, they are one of the only large hospitals in the state that have not experienced layoffs due to the recession.According to Business Week, top executives from New Hampshire’s 23 non-profit hospitals have received substantial pay increases, from 2006 to 2009, which makes their salaries similar to hospital executives in other states, but varies considerably among the hospitals in New Hampshire.The Wentworth-Douglass Hospital in Dover is the seacoast’s leading medical center, featuring a spine center, joint-replacement center, acute care, disease management, wellness programs, trauma center and strong educational program.New Hampshire hospitals pride themselves in their quality of care, expansion and ability to discover and utilize new and improved technologies, and revolutionary ways of treating and diagnosing their patients.

Report: Hospital Discharges Delayed for Older Patients with Nowhere to Go

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File Photo, NHPR
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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.

Transcript

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.

LAFRANCE: Right.

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.

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