Unnecessary Hospitalizations: Bad for Seniors, Bad for the Economy

The January 22 cover story of the Journal of the American Medical Association focused on the growing problem of unnecessary hospitalization. As our nation’s lawmakers wrangle over the topic of health care reform, this is one thing everyone can agree on: these unnecessary hospital trips cost money, and aren’t good for the health of seniors. Policymakers are looking at ways to protect the well-being of our vulnerable seniors and, in the process, saving money for Medicare and consumers.

For Seniors, Is This (Hospital) Trip Necessary?

Hospital care is expensive. Yet according to a recent report from the Medicare Payment Advisory Commission (MedPAC), 60 percent of all Medicare emergency room visits and 25 percent of hospital admissions are “potentially preventable.” And this is not just a matter of money. Hospitals, it turns out, are not always the best care setting for seniors. Researchers are looking at ways to keep older adults out of the hospital. This includes:

  • Encouraging patients to be treated by their primary physician rather than at the emergency room
  • Better preventive care and management of diabetes, heart failure and other common health problems
  • Helping seniors manage their medications
  • Identifying and treating depression, which increases emergency room use
  • Improved healthcare education and information for consumers.

Avoiding the Hospital Revolving Door

Re-hospitalization is also an expensive and dangerous problem. According to the National Association of Area Agencies on Aging (n4a), nearly 20 percent of Medicare patients discharged from the hospital are readmitted within 30 days, costing over $26 billion every year. Why are seniors readmitted at such a high rate? Sometimes they have nowhere else to go—they can’t get an appointment with their primary care physician or don’t understand their care instructions. Studies show that in other cases, patients are released too soon: almost half of all surgical complications happen after discharge. And often, the reason for readmission is unrelated to the condition for which the patient was hospitalized. (See “Is Post-Hospital Syndrome Real?” below for more about this.)

For hospitals, there is a new emphasis on preventing unneeded readmissions. Medicare penalties are one reason for the concern: beginning in October, Medicare began reducing payments to certain hospitals which have high rates of preventable readmission.

Of course, not all readmissions can be prevented. But healthcare agencies are taking steps to help seniors, professionals and consumers address the problem. The Agency for Healthcare Research and Quality (AHRQ) calls for improvements in care transitions between the hospital and care facility or home:

  • Education for patients about their diagnosis and treatment while they are in the hospital and upon discharge
  • Making appointments for needed follow-up care
  • Improved instructions on how to take medications
  • Following up with patients within a few days of discharge

Improved communication is also important. Said Dr. Elizabeth Rasch of the National Institutes of Health, “When a person has an emergency department visit, their primary care providers often don’t know or don’t get the results of that visit, and vice versa. The emergency department often doesn’t know about the complex medical history people bring with them. That’s where things tend to break down.”

The AHRQ also recognizes that patients may be unable to remember discharge instructions. Family caregivers play a valuable role. Hospital discharge planners, geriatric care managers or other professionals may also be of help at this time.

Is “Post-Hospital Syndrome” Real?

Care received in a hospital saves the lives of millions of seniors each year, and helps many enjoy a higher level of independence and quality of life. Yet studies over the past few years have confirmed that a hospital stay can have a negative impact on seniors. In a January 2013 study appearing in the New England Journal of Medicine, Yale University’s Dr. Harlan Krumholz showed that many hospital readmissions are for a medical condition that is different from the initial cause of hospitalization—”post-hospital syndrome,” a 30-day period where patients are at risk.

A stay in the hospital can leave seniors vulnerable to medication problems, urinary tract and other infections, sleeplessness, bedsores, and even falls, which can lead to a more serious problem than that for which the senior was admitted. Of special concern is hospitalization delirium—a sudden state of confusion that sometimes occurs after surgery or a serious illness. This temporary event is sometimes mistaken for dementia—and delirium has been found to raise the risk of or hasten the course of cognitive decline in some patients.

Hospitals are making changes to support better outcome for elders. Some have opened geriatric emergency departments to meet the special needs of frail older patients, with such features as specially trained personnel, a quieter setting and thicker mattresses for comfort and bedsore prevention. Experts are calling for more geriatric training in medical and nursing schools, as well as policies that make geriatrics a more attractive specialty for med students.

Consumer Resources

Download the Agency for Healthcare Research and Quality booklet: “Taking Care of Myself: a Guide for When I Leave the Hospital.”

The Joint Commission healthcare accreditation organization offers the “Speak Up” series of patient education brochures and videos.

The Eldercare Locator offers the online booklet “Hospital to Home: Plan for a Smooth Transition.”

Read more about the post-hospitalization syndrome study in the New England Journal of Medicine.

Copyright © AgeWise, 2013


Tips for Buying Long-Term Care Insurance

Information from Kaiser Health News on the complicated topic of long-term care insurance.

The question of whether to get long-term care (LTC) insurance bedevils consumers and their advisers. Unlike medical insurance, it is intended primarily to cover people who need assistance with so-called activities of daily living—for example, the care of a dementia patient or someone recovering from a broken hip. It can be expensive: Premiums range from $1,000 to $5,000 a year, depending on the age, sex and health of the purchaser as well as the extent of the coverage. And policy details can be confusing.

Kaiser Health News experts offer four things to consider as you make the decision:

  1. Determine if you qualify financially. Don’t buy if the out-of-pocket cost for the coverage would be more than you can afford. Consumer Reports advises people that if their net worth, excluding their home, is below $300,000, long-term care insurance is not a good buy for them. The National Association of Insurance Commissioners also recommends that consumers spend no more than 5% of their income on a long-term care policy. If you need long-term care but have few financial resources, Medicaid should quickly kick in to pay, although that will probably limit your choices for care. On the other hand, if you have a lot of resources (some financial advisers put that threshold at $2 million), you may be able to self-insure and pay the costs as they arise, thereby eliminating the need to buy a policy.
  2. Shop around. Unlike car insurance where you can switch carriers easily, it can be expensive to change long-term care policies because the premiums increase as you age and you lose the investments already made. Comparison shopping is critical. Some companies and associations (such as alumni groups and AARP) offer group policies with relatively liberal eligibility, making it easier to obtain coverage if the policyholder has any health issues. However, these policies may have more limited benefits than individually purchased plans.

If you are young or in excellent health, a group plan may also be more expensive; you may end up paying more to subsidize your less healthy peers. And if you are certain you want LTC insurance, the younger you are, the better. Your annual premiums will be smaller, and you have less chance of being denied for health reasons.

  1. Know what’s covered. Policies differ greatly, so know what you are buying. What services are covered? How long is the disability period before benefits kick in and what happens if you move from one facility to another? How much does the policy pay per day for nursing home care, home-health care and assisted living? How long will benefits last? Is there an inflation adjustment that anticipates rising medical costs as you age? How long are benefits extended (one, three or five years, or indefinitely)? Who determines benefit eligibility—your doctor, or the insurance company’s doctor—and on what basis? Are pre-existing conditions excluded? Does the policy cover mental or nervous disorders, alcoholism, drug abuse or self-inflicted injuries?

The National Association of Insurance Commissioners advises consumers to look for policies that include at least one year of nursing home or home health care coverage, including intermediate and custodial care; coverage for Alzheimer’s disease; inflation protection; a guarantee that the policy cannot be terminated because you get older or your health deteriorates; no requirement that the beneficiary has to first be hospitalized to receive benefits; and a 30-day cancellation period after purchase.

  1. Check out the insurance company. Review a carrier’s record with your state insurance commissioner’s office. Find out how long it has been in business, its complaint record, and history of raising rates. Stick with a company that has an A financial rating.

Also, the National Association of Insurance Commissioners ( and the American Association for Long-Term Care Insurance ( have consumer guides on their websites. The Department of Health and Human Services provides extensive information on its National Clearinghouse for Long Term Care website (

This article was reprinted from Kaiser Health News ( with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. Read Calculating a Long-Term Care Policy ( to learn more about whether long-term care insurance is a good idea for you.