Readmissions in assisted living: Closing the revolving door

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Steven Fuller, D.O., Ph.D.
Steven Fuller, D.O., Ph.D.

Avoidable hospital readmissions are a menace and a scourge to the American healthcare system.

They are due to a dysfunctional discharge and follow-up process. They assign patients (victims) the impossible task of understanding medical Greek when the language these victims speak is anything but Greek. And they often demand that patients obey a series of impossibly complicated instructions that are bound to fail from the get-go. So blatant is this dysfunction that the Robert Wood Johnson Foundation refers to readmissions as a “revolving door.”

As a physician with prior medical practices in hospital-based, office-based and community-based medicine, I have been complicit in this dysfunction for more than 25 years. I have been guilty of contributing to the sky-high 20% 30-day readmission rate and helping waste $17 billion that resulted in the escalating series of financial penalties now imposed on hospitals to encourage them to wipe out this blight.

On the flip side, my professional experiences in these many different healthcare settings have taught me important and valuable lessons. When it comes to readmissions, I have learned what works and what doesn't work. And I'd like to share my insights so that others may build on this foundation and eliminate this readmission scourge once and for all. The target of my focus is the assisted living industry.

For a readmissions program to be adopted and implemented, communities must be convinced the program will add value. This challenge is not as obvious as it might seem, because assisted living communities are different than other settings where seniors receive help with their health. Assisted living a social model (not a medical model) of care, with a primary focus on hospitality. And yet assisted living communities increasingly are charged with the management of a complex, even staggering, assortment of resident health and social problems and increasing resident health acuity. Despite these obvious health trends, assisted living is only a peripheral focus, at best, in the larger healthcare system.

To illustrate how resident health tangibly affects assisted living, consider the following sobering statistics. Over the past 15 years:

  • Length of resident stay has plummeted from 36 months to 22 months.
  • Annual resident turnover, pressured by acuity creep, has skyrocketed from 41% to 54%.
  • The leading reason for resident turnover is declining resident health, and this has climbed sharply from 72% of those residents who leave to 92% currently.

Considering that the cost of each turnover is conservatively estimated to be about $4,000 per turnover, these statistics should provoke financial incentive for assisted living communities to more closely align with healthcare leaders as partners to advance the paradigm of assisted living on behalf of our seniors.

My mission is to make contributions to the assisted living industry that will help close the revolving door for readmissions, and my goal is zero avoidable readmissions.

With this goal in mind, I offer the following insights, or lessons learned.

A successful readmissions program must at least have these characteristics:

  • Easy to implement and cost effective.
  • Easy access to online training.
  • Educates how to achieve a close connection between residents and their doctors.
  • Educates how to achieve a close connection between communities and local doctors and other providers of healthcare services.
  • Educates how to achieve efficient communication on all resident healthcare issues.
  • Educates how to achieve the engagement of all employees in identifying early changes in resident health condition, and this includes an action plan.
  • Targets and facilitates tracking of key metrics.
  • Promotes a “person-centered,” not “process-centered,” approach, and empowers a direct, straight-line connection between residents and their physicians.

Anticipated outcomes of a readmission program

There are undoubtedly additional beneficial outcomes, and they all have positive financial consequences that are achieved from improved resident health:

  • Reduced trips to the emergency department.
  • Reduced hospitalizations.
  • Reduced readmissions.
  • Reduced ambulance calls.
  • Reduced resident turnover.
  • Increased resident length of stay.
  • Reduction of overall healthcare costs.
  • Inclusion in health referral networks.

A wide array of readmissions programs have been implemented by hospitals across the United States, and most of them yield striking improvements. Skilled nursing facilities, which soon also will be subjected to avoidable readmission penalties, similarly have more and more choices among programs that result in significant advances.

Assisted living has Straight Line, a new online readmissions program developed specifically for this industry. Three video teaching modules, with downloadable PDF text that contain all the essentials, can be viewed from anywhere.

We should never accept readmissions as being the “new normal.” Instead, we should close the revolving door and view zero hospital readmissions, at least in assisted living, as the new normal.

I encourage everyone to embrace this goal of zero tolerance for readmissions.

Steven Fuller, D.O., Ph.D., founder and president of Straight Line, is a triple board-certified physician-entrepreneur who develops programs in support of an integrated care model of senior housing that equally includes real estate, hospitality and healthcare. He may be reached at stevenfuller@straightlineconnect.com.

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