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Hospital Critics Rip After Care Planning

As an only child, Jackie McGrath looked after two elderly parents with dementia and her experiences with the hospitals were as eye opening, as they were frustrating.

When her parents were, discharged McGrath told a legislative panel Wednesday, hospitals failed to assess adequately their after-care requirements.

Instead of returning them to the small board-and-care facility where they felt at home, they were steered to costly nursing homes, until she intervened.

"Virtually any frail senior will be viewed by doctors and (hospital) discharge planners as nursing care eligible," said McGrath, policy director for the California chapter of the Alzheimer's Association.

The joint hearing of the Assembly Aging and Long-Term Care Committee and the Assembly Health Committee paying attention on the discharge plans that hospitals make available to patients prior to releasing them.

Experts told the panel that as health care costs have risen, hospital stays have abridged and patients are increasingly probable to leave with inadequate after-care plans and end up back in the hospital.

Barbara Biglieri, policy director for the California Association for Health Service at Home, said an estimated 25 percent of patients would revisit to the hospital within the first week after discharge, and 56 percent within three weeks.

The result, say researchers and care providers, is a system that wastes money while limiting the choices of older adults and people with disabilities.

Home support health services cost the state far less than care in hospitals or skilled nursing facilities. Nevertheless, the panel was told, state Medi-Cal and federal Medicaid regulations routinely steer patients to institutional facilities and raise barriers for those looking to return to their homes.

With the number of Californians age 65 years and above expected to double from 3.5 million to more than 7 million by 2050, experts say, those rules should to be changed for the state to manage the cost of caring for its aging population.

California hospitals already discharge more than a million patients every year above the age of 65 years, according to the federal Centers for Disease Control and Prevention.

"Better discharge planning can mean the dissimilarity between a patient getting better, getting to stay home, or getting hospitalized again," said Assemblywoman Patty Berg, the Eureka Democrat who chairs the Aging and Long-Term Care Committee.

However, Nan Brasmer, president of the California Alliance for Retired Americans, said most hospitals do not help patientís access support services to get well at home.

"Hospitals have too few social workers who have many, many other assignments," said Brasmer. "Discharge planning is often at the bottom of tasks that they are expected to do."

Shelley Johnson, a registered nurse who stood for the California Hospital Association at the hearing, testified the industry standard is a manageable 20 patients for every caseworker.

Johnson said at North Bay Healthcare, the two-hospital system in Solano County where she works, caseworkers "work with patients, families and care givers to develop a plan that customizes their medical needs in addition to their social and financial resources."

"We will often spend hours working on one patient while managing other patients' needs," said Johnson.

Lynn Daucher, director of the California Department of Aging, said the state is developing a plan to get better elderly patient care.

"California has received a lot of federal grant money, in drips and drabs, that will assist us with these transition issues from hospital and nursing facilities," said Daucher.

Toby Douglas, deputy director of the state Department of Health Services, said his department too is developing a "coordinated care management pilot program."



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