Ready-Set-Go Home: Avoiding Hospital Re-Admissions
If you have ever been admitted to the hospital, the thing you probably longed for most was to return to the safety and comfort of your own home. According the Centers for Medicare and Medicaid Service (CMS), “…nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—are readmitted within 30 days, at a cost of over $26 billion every year.” Visiting Angels Upland is committed to helping seniors stay at home where they are most comfortable. We offer a variety of comprehensive tools and resources to assist with this endeavor.
Why Readmissions Occur
To address the high rate of hospital readmissions, we must first understand why they occur. The reasons for readmission are varied, but often include:
- Difficulty managing a disease or illness at home
- Exhaustion due to disrupted sleep and eating schedules while in the hospital
- Lack of follow-through with discharge instructions
- Medication issues - not taking appropriately, missing doses, etc.
- Lack of timely follow-up with medical appointments or lack of follow-through with medical instructions
Our Three Prong Approach
At Visiting Angels Upland, we address these issues and others by using a three prong approach to care for our clients returning home after a hospital stay.
- At the hospital – with Visiting Angels Upland, we offer peace of mind. If a client is hospitalized, we visit him or her at the hospital upon request. We believe collaboration with the hospital discharge planner is necessary to help ensure success at home. During the hospital visit, we provide our client with a copy of ‘Ready-Set-Go Home’, a discharge planning guide. Specific items in the guide prompts the client to ask pertinent questions about issues that impact readmissions, such as: symptoms to report, times and dates of follow up appointments, medications, special dietary needs, home equipment needs, etc.
- At the client’s home – Our caregivers are the ‘eyes and ears’ in the home. Caregivers have unique insight into why clients don’t follow up with appointments, why they miss medication doses, and other actions that can lead to re-admission. Caregivers can share this information with the case manager or supervisor so any issues can be addressed. Additionally, many of our caregivers are trained to provide palliative care. This training enables our caregivers to understand the importance of reporting changes in condition promptly so any problems can be addressed in a timely manner.
- At the Visiting Angels Upland office – behind the scenes, office staff utilize tools and resources to identify and track clients who are at high risk for re-admission. Staff can help facilitate medication delivery, equipment and food delivery services, offer medication and appointment reminders, and accompany clients to appointments.
Serving the Inland Valley Foothill Communities of California
Visiting Angels UPLAND, CA172 D St
Upland, CA 91786