Closing the Hospital Revolving Door

I just read a good article about closing the hospital revolving door. It’s about helping older adults prepare in advance for what happens AFTER they are released from the hospital.  Some studies show that 40% to 50% of re-admissions occur because patients don’t understand the discharge instructions and don’t comply.  In some instances, resources that might be needed post-discharge aren’t available in their community. These issues connect with some of the things we heard in our Aging with Dignity & Independence initiative (ADI) and what I am working through now, with my own parents.

In the research of best practices and resources for the ADI report we came across Project Independence - a program of trained volunteers who help patients transitioning from hospital discharge to independence at home.  The volunteers are under the supervision of a public health nurse case manager and are trained to help patients understand and follow-through with their discharge plan.  They are able to provide guidance and resources as well as be a supportive companion to the isolated persons in the community.

With this program the re-admission rate is claimed at 6%. This is an example of a strategy that can make a difference in one’s health and well-being as well as the ability to remain in one’s home.

This is food for thought. What approaches are being tried out in our community?  What might we do differently?