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There’s no place like home

Monday, June 03, 2019
Dan Ansel and Geri Lynn Baumblatt There’s no place like home. But going home to recover after a hospital stay can be daunting. And there’s good reason for concern. Even with the strides made in transitions to home, nearly 20% of discharged patients are readmitted within 30 days and over 50% within 1 year. 1
When people don’t thrive and recover well at home, it’s often because of the 3Ms: Medication,  Memory, and Mobility.
  • Medication - Can you read the medication label? Remember how to take your medication? Do you have the hand dexterity to open the container? How about numeracy and health literacy skills to understand the instructions?
  • Memory - Can you successfully sequence self-care steps? Do you need a list or visual cues?
  • Mobility - Can you sit or stand safely; get in and out of a tub?

It’s easy to see how a problem with any of the 3Ms can contribute to a fall, medication issue, or infection. And not being able to do things for yourself, even temporarily, is often emotionally draining. I remember coming home after a car accident with my arm in a sling. It was upsetting when I couldn’t figure out how to open and pour a glass of milk for myself. The next few days did not go well in terms of self care.
One way to help people return home successfully is Occupational Therapy (OT). A study in Medical Care Research and Review by Rogers, et al. 1 used Medicare claims and cost data to look at the association between hospital spending for 19 spending areas (including OT) and 30-day admission rates for 3 conditions: Heart Failure, Pneumonia, and Acute MI. . They evaluated 2,791 hospitals for the heart failure analysis; 2,818 hospitals for the pneumonia analysis; and 1,595 hospitals for the acute MI analysis The findings:
Occupational therapy was the only spending category where additional spending has a statistically significant association with lower readmission rates.”
OTs ask and address a key question:

Can the individual be safely discharged into her or his environment?
OTs assess the individual’s ability to perform activities of daily living (ADLs), environment, and the specific tasks the individual needs to be able to do. They analyze how any problems intersect and then create strategies to improve function, safety and independence. Whether it’s helping the patient gain strength or re-master a task, modifying their environment by installing grab bars or lowering where cabinet items are stored, or training family caregivers -- these are critical factors for success and for quality of life.
The study found these 6 OT interventions can improve transitions to home:2
  1. Train family caregivers. This is definitely underutilized and can start during the hospital stay. Caregivers need a better understanding of their loved one’s health condition, as well as skills training.
  2. Determine if patients can safely live independently, or if they need rehab or nursing care.
  3. Address existing disabilities with assistive devices.
  4. Perform home safety assessments before discharge and suggest modifications.
  5. Assess cognition and the ability to physically manipulate things like medication containers. Provide training when necessary.
  6. Work with physical therapists to increase the intensity of in-patient rehab.
OTs can play a vital role in transforming health care in acute and post-acute settings by looking at the factors that affect health, specificly daily habits and routines, with the goal of improving function, health literacy, independence, and the safety of patients as they return home.
This creates a better patient experience, boosting confidence and self-efficacy, while improving outcomes and ensuring patients can safely return where they most want to be: Home.
  1. Centers for Medicare and Medicaid Services. (2012b). Report to Congress: Post Acute Care Payment Reform Demonstration (PAC–PRD).Washington, DC: U.S. Department of Health and Human Services. Retrieved from
  2. A. T. Rogers, G. Bai, R. A. Lavin, G. F. Anderson. Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission RatesMedical Care Research and Review, 2016; DOI: 10.1177/1077558716666981

Dan Ansel is co-founder and President / CEO of Private Health News and Active Daily Living: content marketing and population health platforms that build ongoing, targeted relationships with health consumers, clinicians, employees, and family caregivers – and help seniors stay active, safe and independent. He frequently speaks at national conferences and publishes articles on: Managed Medicare, Acquisition and Retention, Work / Life programs, Direct Contracting with Employers, and Behavioral Health Care.  He has masters degrees in Educational Psychology and Health Care Services Administration, and is a Certified Aging-in-Place Specialist.

Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn

Tags: patient engagement, communication, personal healthcare, patient education, experience, patient
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