Study finds high rates of hospital readmission out of home care for older adults

U of A researcher calls for better continuity of care for the elderly as the readmission rate is also high out of long-term care.

Older adults who were discharged from hospital into a home-care setting were 40 per cent more likely to be readmitted to hospital within 30 days of discharge, according to University of Alberta research.

"Our study also showed that older adults who were discharged from hospital back into long-term care (LTC) were 35 per cent more likely to be readmitted, and 30 per cent less likely if they were discharged from hospital into LTC for the first time," said Andrea Gruneir, a professor of family medicine and epidemiologist in the Faculty of Medicine & Dentistry.

"These rates of ending up back in hospital within 30 days are all too high, and this first time we have been able to see how being different care settings outside of hospital leads to differences in health outcomes like 30-day readmission," she added about the Canadian Medical Association Journal study, for which she was the lead author.

Gruneir explained that being readmitted to hospital within 30 days of discharge is considered unacceptable.

"Not only does it raise the question whether the condition was properly cared for, both in hospital and in planning for discharge, it's extremely costly for the system, and disruptive for patients and their families," she said.

The study, which included 701,527 patients, also showed that 20 per cent of older adults who were readmitted to hospital died during readmission.

"Obviously, some of these patients were nearing end of life, and this finding again raises the issue that transitions are not recommended for quality end of life care," she said, adding that the study adjusted for a number of variables including health status.

Improvements needed

Why home care had the highest rate of hospital readmission isn't clear but Gruneir said there is speculation that home care does not meet patients' full scope of needs, or there is a mismatch of needs and services provided.

"The other piece is that in our health-care system, home care really operates independently from hospitals and physicians. There's little integration between primary care and home care, and it may even be, in some cases, the patient has been in hospital and the physician does not know."

Gruneir said that the lower rate of readmission for patients entering LTC for the first time may be because they were in hospital designated as what's called "alternate level of care" for a period of time before finally getting to a LTC facility and getting the care they really need. Whereas the higher rates for those returning to LTC may be because of premature hospital discharge.

Ideally, she noted, we need to be reducing the number of health-care transitions older adults make because they are stressful for patients, especially those with dementia.

She added these transitions may result in lack of communication between the different health-care settings, which can lead to gaps in care, and are stressful for caregivers and families.

"Overall, we need a better understanding of how to support an aging population with more complex chronic conditions including dementia-where hospital is a place of last resort-and they are getting the care in the places they need it," said Gruneir.

"There is no one answer but part of it is taking a comprehensive look at how we can strengthen our continuum of care so we can support people where they live. Part of it is providing the right services, the right staff, funding and better integration across the health-care system."