Column: Home for holidays a goal for terminally ill
The holidays are a time of family, friends, traditions and gratitude.
When a loved one has a terminal illness, the season can also mean added stress, fatigue, and financial burdens. Most families would not want to spend the holiday season in and out of an emergency room, yet nearly one in five Medicare beneficiaries is readmitted to the hospital within 30 days of release. According to the New England Journal of Medicine, this translates to $17.4 billion in Medicare spending on patients whose return trips could have been avoided.
Avoidable hospital readmissions among Medicare beneficiaries has become a top priority for both policymakers and the Centers for Medicare and Medicaid Services as hospitals feel added pressure to help patients remain at home. The CMS has taken on several initiatives to reduce readmissions from penalizing hospitals with high readmission rates to implementing shared savings programs in an effort to increase care coordination among providers.
There are some return trips to the hospital that are unavoidable due to complications, new and unrelated problems, or anticipated steps of certain treatment plans. Some patients are also readmitted because they live in a region where hospitals are used more frequently as a place of care for illnesses.
Regardless of where patients reside, education and support are key factors in preventing readmissions. Too often, a rushed discharged process and a lack of necessary follow up care leaves discharged patients unable to follow instructions about a new diagnoses or new medication. The Agency for Healthcare Research and Quality reported that while patients with one or more chronic conditions represent just five percent of the patient population, they account for more than 50 percent of the health care costs.
Increasingly, hospitals are forming collaborative partnerships with palliative care and hospice providers to combat avoidable readmissions. For terminally ill patients, hospice is one resource available to help patients remain home for the holidays. Hospice and palliative care providers work closely with patients and families to identify care preferences, manage symptoms, and address clinical, emotional and spiritual needs through a team approach. This type of care allows patients to pick up the phone in a time of crisis and receive medications at home. During the holidays, families can spend more time creating memories and sharing traditions instead of making emergency room trips.
Integrating palliative care services early, and making timely and appropriate hospice referrals can not only improve patient experiences, but address some of the most important issues faced by hospitals today: quality improvement, increasing coordination, preventing complications, reducing costs - and ultimately, return trips to the hospital in a patient's final stages of life when the comforts of home and quality time with family are most important.