Adequacy of Discharge Plans and Rehospitalization among Hospitalized Dementia Patients
Cummings, Sherry M., Health and Social Work
Because of the rapid growth of the elderly population and the decreasing number of days that patients are able to remain in the hospital, the task of discharge planning has become increasingly critical and challenging. This article reports on a study undertaken to examine the adequacy of discharge plans developed for dementia patients and to investigate factors related to inadequate plan development and patient readmission. Study results suggest that a sizeable proportion of dementia patients are discharged without adequate aftercare plans and are at risk of rehospitalization. The findings of this study point to significant family and resource-related factors that compromise discharge plan adequacy for dementia patients. Implications for practice, education, and policy are discussed.
During the past two decades regulatory and marketplace forces have combined to exert increasing pressure on hospitals to curtail expenditures and conserve health care resources. To remain financially viable, hospitals are undergoing major structural reorganizations and are continuing efforts to shift their focus from acute inpatient care to more cost-effective outpatient services. The trend toward decreased length of stay (LOS) that began with the introduction of diagnostically related groups (DRG's) in 1983 has been strengthened by the financial pressure exerted on hospitals by the managed care health system (Robinson, 1996). In this environment discharge planning has become an increasingly critical activity. The challenge of developing a comprehensive plan of care to meet patients' post-discharge needs is heightened not only by the decreased amount of time available in which to plan but also by the increasingly complex set of problems brought to the inpatient setting by an expanding elderly patient populati on.
In addition to acute illnesses that result in hospitalization, elderly people experience a high prevalence of chronic illness and functional disabilities that complicate the recovery process. The growth in the number of elderly people has been accompanied by an increase in the number of people with Alzheimer's disease and other related dementias. Such people require comprehensive aftercare to address not only medical and functional needs but also cognitive and social deficits. This combination of medical illnesses and incapacities experienced by cognitively impaired elderly people often creates a complex constellation of post-discharge needs (Cox & Verdieck, 1994), because of patients' varying levels of cognitive impairment, the need to involve family members in aftercare planning, and the need to secure services designed to address the special requirements of cognitively impaired people. Not surprisingly, dementia patients have an extended LOS. Whereas the duration for the average hospital stay for patients is 3.8 days, patients with a dementia typically stay 9.4 days (Health Care Information Analysts, Inc., 1998).
Adequate discharge planning for dementia patients is critical if hospitals are to meet the challenge of remaining financially viable while serving the needs of a rapidly growing older population. Inadequate discharge plans may result in insufficient post-discharge care and, therefore, readmission to the hospital. Researchers have found that cognitive impairment and a decline in cognitive functioning are associated with greater aftercare needs (Travis, Moore, & McAuley, 1991) and early readmissions (Severson et al., 1994; Weiler, Luben, & Chi, 1991). Readmission of elderly people can have serious consequences. Studies indicate that older people who must be readmitted are more severely ill and more functionally dependent than they were during their first admission (Berkman, Walker, Bonander, & Holmes, 1992). In light of this fact, it is not surprising that rehospitalizations drive up health care expenditures. The cost of a readmission ranges from 24 percent to 55 percent higher than the cost of the original in patient stay (Berkman & Abrams, 1986). …