Continuum provides comprehensive services to keep elderly independent
Hospital responds to community need
Faced with a growing population of senior citizens, shorter lengths of stay, and limited reimbursement, West Georgia Health System in LaGrange has developed an integrated continuum of geriatric services.
West Georgia Health System developed the senior continuum of care in response to the needs of the community, says Mary Lynn Faress, RN, vice president of the health system.
Because of declining reimbursement and pressures for earlier discharge, many senior citizens were being sent home without the resources to live independently, she adds.
In the county in which the hospital is located, people 65 and older make up 13.7% of the population, compared with 10.1% in the rest of Georgia, Faress says. "We know demographically that the need is there."
The health system includes a 276-bed acute care hospital and an attached 150-bed skilled nursing facility with 24 subacute beds; a 16-bed freestanding hospice; and a 12-bed personal care assisted-living facility three miles from the hospital. The health system broke ground in March 1998 for a 120-bed assisted-living facility with a 20-bed Alzheimer's unit.
Adult day care a new service
The hospital just opened an adult day care program within the skilled nursing facility to provide another service for senior citizens who don't need 24-hour-a-day assistance. Two volunteer programs provide companion services for discharged senior citizens five days a week.
The senior continuum of care was developed as the rehab staff began working with orthopedic surgeons on developing critical pathways for joint replacement and hip fracture patient groups. The staff initially developed critical pathways for acute care patients and then added the subacute portion.
"We had long-term care beds available and realized that we had an opportunity for a subacute unit. We planned for it with the physicians, and that is why it has worked so well," Faress says. "Ideally, everyone is finished after 14 days in the subacute unit, but if there are complications, some patients may remain as long as 30 days."
The 24-bed subacute unit was opened in the skilled nursing facility in 1995. The hospital has no dedicated rehab beds. Instead, patients receive rehab during their post-acute care stay. Before the subacute unit opened, elderly patients often had lengthy stays in acute care and were discharged with home health therapy services.
Now patients who come into West Georgia with a hip fracture or for total hip replacement surgery will stay in the acute care hospital for four or five days and will be transferred to the subacute unit. They follow a critical pathway that provides seamless care between the two units. (See pathway, inserted in this issue.)
Subacute hip fracture patients get intensive nursing, physical therapy, and occupational therapy and usually are discharged to the community within 14 days, Faress says.
"Now they're going home more independent, and family members feel more comfortable because they have had more time to prepare the home setting and to prepare psychologically for the family member to come back home."
Patients and their families are pleased with the new system, she adds. "We have had the unusual experience of having several patients recently who were hospitalized for hip fractures before the subacute unit opened and were discharged with home therapy services. They report being much more independent and more comfortable with going home after their subacute stay," she says.
Patients in the subacute unit get therapy five or six days a week depending on their needs. The hospital contracts with an occupational therapy service to provide OT in the subacute unit. The other therapy staff are from the hospital rehab department.
Subacute costs are considerably lower than hospital costs, although they are somewhat higher than home health costs, Faress says. However, a subacute stay offers more intensive rehab services than what is available through home health. Also, patients report a better quality of life, which helps reduce readmissions because the subacute staff can pick up on complications earlier.
"In the subacute unit, we have medical staff looking after the patients 24 hours a day. When patients are at home, problems like pneumonia or infections may be ignored until they become a major problem," she says.
Elderly patients who are at risk for pneumonia after anesthesia may not move around much at home and can ignore early symptoms that could be treated easily, Faress says.
When patients are discharged from the subacute unit, they may sign up for visits from Senior Companion Services or an AmeriCorps volunteer. Volunteers in both programs spend four hours a day, five days a week in the homes of former patients, helping with activities of daily living and providing companionship. (For more details, see story, above.)
The programs, run by the department of volunteer services, pair elderly patients who are being discharged from the hospital with a senior citizen or younger volunteer. The volunteers make sure the former patients get their meals, take their medicine, and keep their physician appointments.
Keep patients from coming back
The program has demonstrated a decrease in readmissions and has cut hospitalization costs, Faress says. For instance, hip fracture patients can be discharged to their homes sooner if there is someone to be with them during the day.
Another option for senior citizens who are being discharged from the hospital is the newly opened Senior Day Care program, which operates from 6:45 a.m. to 5:30 p.m. weekdays. Candidates for the day care program must be ambulatory, although they can use a walker or wheelchair, and must be able to follow simple commands. Day care patients are involved in some of the same activities, such as recreational therapy, as the long-term care residents.
"The program is more activity based than health care based. It's for someone who otherwise would be at home with little activity or social contact," Faress says.
Families pay $30 to $40 a day for the adult day care, based on the level of care the patients need. The hospital charges the lower level for patients who need minimal assistance, such as being reminded to go to the bathroom or assistance with cutting their food at lunch.
Seniors may participate in the program between two and five days a week. The staff are keeping space open for drop-ins; however, participants must stay at least four hours.
[For more information, call Mary Lynn Faress at (706) 845-3257.]
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