Initiative reduces extra days, unnecessary admissions
Hospital sends patients directly to assisted living
To alleviate the problem of "social admissions" from the emergency department (ED), Northeast Medical Center in Concord, NC, established an ED case management staff and made arrangement with local assisted living facilities to admit patients directly from the ED. For instance, a family member may bring a patient to the hospital and say the patient is weak, won’t eat, and the family can no longer take care of him or her. The patient doesn’t need to be admitted to the hospital, but the family doesn’t feel comfortable taking him or her back home.
Patients who live alone may come to the ED with a broken bone. They are medically stable but have no one to help them with their activities of daily living. "These are patients who don’t have severe medical conditions that require hospitalization, but there are multiple reasons that their families can’t take care of them. It’s mostly a social issue and not a medical issue," says Dianne Hansford, RN, MSN, director of case management.
The ED-based case management staff have worked with assisted-living facilities in the area and provide them with the paperwork to admit the patients. The team includes both social workers and case managers who work with patients who come into the ED. "We have someone on call 24 hours a day. We’ve sent people to assisted-living facilities in the wee hours," Hansford adds.
The case management staff talk to patients and families about their options if they can’t be cared for at home and don’t meet the qualifications for hospital admission. If the patients don’t have Medicaid to pay for assisted living, the case management staff help them locate a sitter or home health care. Patients who are eligible for assisted living generally don’t meet the medical necessity guidelines for Medicare to pay their expenses and must pay them out of pocket. "We give them all the options and let them make an informed decision," she says.
The case managers encounter one or two patients each month who refuse to leave. Sometimes, they are fearful of being discharged without on-the-spot medical care available. In other cases, the family is not prepared to care for them at home, Hansford says. When a patient refuses discharge or placement at another facility, the social workers begin working closely with the patient and the family. "We tell them they will be responsible for the bill, based on Medicare guidelines for noncoverage," Hansford says.
The social workers help ease the transition by working with family members to assure them that the patient no longer needs acute care and helping them become comfortable with discharging the patient to home or another level of care. "A lot of it is upfront work. One of the things we monitor is a patient’s perceived readiness for discharge," Hansford says.
The case management department works closely with the hospital’s director of patient satisfaction to see if the patients report on their post-discharge surveys that they were ready to go home. "We are working with the patient satisfaction staff and the physicians to identify how we can better prepare patients for discharge," she says.
To alleviate the problem of social admissions from the emergency department, Northeast Medical Center in Concord, NC, established an ED case management staff and made arrangement with local assisted living facilities to admit patients directly from the ED.
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