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Hospital or Hotel: Social Admissions.

Posted Jan 22 2009 5:54pm
T hey're often called "social admissions". Those folks that are typically elderly that cannot take care of themselves anymore or their family members don't want to/can't take care of them either. Where do they go? From a medical perspective other than being in their latter decades of life and having some limitations with mobility there is nothing acutely wrong with them. The only option from the family's perspective is to send them to the hospital. Quite often the home care giver is exhausted both mentally and physically. They have no more to give or as I mentioned are unable to provide the required care/supervision any longer.

Elderly patients who are not independent often have their elderly spouse carrying for them. Younger patients who are disabled in their forties or fifties are being cared for by their parents who are in their seventies and eighties. Some elderly people live alone and their neighbors or other family members travel each day or several times a day to their home to check on them, countless times arriving to find their elderly family member lying on the floor after a fall. The end result many times is these people are taken to hospital.

Arriving by rescue or family member with nonspecific complaints these now patients in the emergency department often have no any acute findings with their work up. They are planned for discharge. However these poor souls have no way of getting home. They have no one to call for a ride. In some cases their spouse or partner and even younger family members do not want them to come back home. The hospital staff has a problem.

Inappropriate admissions are a significant fiscal liability for any hospital. The organization will not be reimbursed or compensated by third party payers for care and time that is deemed not to be a medical necessity. That being said hospitals cannot just discharge people to the curb side because there isn’t anything wrong with a them and they can’t get home – referring the elderly.

Many a time I have heard providers state “we are a hospital, not a hotel”. The statement is true, hospitals are places to receive care and not a weekend getaway option so family care givers can go on vacation. Some use hospitals as an elder daycare of sorts during family vacations, a place to drop mom or dad off while they go away. Hospitals are not a collection point for society’s social problems, but what options are out there for families that are care givers?

The issues and concerns that surround our golden years are numerous. As we age our care needs typically increase and our independence decreases. With people living longer and the 85 year old age group rapidly growing the issues of social admissions to hospitals will grow. Some call it the silver Tsunami which is already lapping at the shores of healthcare now. The baby boomers are coming and healthcare as an industry needs to be prepared.
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