For the older people at Long Term Care facilities, nursing homes, and assisted living facilities, even small issues — like a simple fall — end up with a transfer to the emergency room. Those visits to the ER can often mean a hospital stay as well. And of course, hospital stays can cause backtracking for overall strength, wellness, dementia, and disease. The best case scenario — a visit to a doctor instead of a visit to an ER — can still mean bouncing from provider to provider, with a lot of stress and physical challenges along the way.
But aren't these ER visits, hospital stays, and doctors' visits simply the necessary realities of life. New insights and ways of working point to innovative solutions to this Business As Usual problem.
There are 30,000 assisted living facilities in the US. As the New York Times reports, “most assisted living facilities have no doctors on site or on call; only about half have nurses on staff or on call.”
That means that if an event happens — a virus, a fall, a concern about a worsening condition — it results in a transfer, doctor's appointment, or ER visit, the vast majority of the time. Of course, coordination of medical transfers, tests, appointments, and the like can be a huge challenge for any person — but throw in significant physical challenges and perhaps cognitive impairment and the challenges compound.
“The assisted living industry has to recognize that the model of residents going out to see their own doctors hasn’t worked for a long time,” said Christopher Laxton, executive director of The Society for Post-Acute and Long-Term Care Medicine. “It’s an expensive, disruptive response to problems that often could be handled in the building, if health care professionals were more available to assess residents and provide treatment when needed.”
It's a way of caring for people that hurts the patient, the provider, the Long Term Care facility, and even the hospitals. Hospitals will stay away from sending their patients back to the community if they are afraid they’ll be readmitted within 30 days of discharge. And Long Term Care organizations may shy away from getting the right care for their residents if it often results in backsliding in their care.
So what is the solution?
One solution has been to have a geriatrician on staff. But realistically, that doesn’t solve the problem. There will be myriad medical problems that fall outside of the expertise or time of that provider.
There are two key things that need to happen:
- Hospitals should partner with assisted living and nursing home facilities that have the means to do medical collaboration and prevent readmissions.
- Long Term Care facilities must find ways to get the medical consults they need without putting their residents through the stress and danger of ER visits and bouncing among doctors’ appointments.
To facilitate those goals, though, hospitals, doctors, nurses, aides, and care providers at Long Term Care facilities need a platform to collaborate. The ideal scenario is that if a resident has a fall that isn't actually worrisome but could use "an extra pair of eyes," an aide can take a photo or video, consult with a trusted provider at a practice or hospital in the community, and keep the patient at home base until or unless a transfer is needed. It's good care in every way: it saves money, decreases readmissions, and ultimately supports the best possible health, wellness, and quality of life for the patient. It's a classic example, too, of why email or text messaging — in addition to not being HIPAA compliant — aren't nearly sufficient. In cases like this, whole teams are involved and cases need to by asynchronously collaborated on, over the span of time. A one-off question won't fit the bill.
Care coordination and healthcare collaboration aren't a panacea. But I do believe that when it comes to Long Term Care, the impact of collaboration and coordination can be dramatic.
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