Last year, in a piece for The Nation about hunger among the elderly, I wrote this:
Malnutrition is one of the greatest contributors to costly hospital and nursing home admissions and readmissions. At the same time, Medicare is trying to reduce readmissions by penalizing hospitals. Many seniors on waiting lists have just come from the hospital and need food to help them heal. Without it, program directors say, they may return to the hospital.
I thought of that passage recently, with the release of the latest hospital penalty data from Medicare. Elsewhere at CJR, Jordan Rau shows how journalists can use the federal data to examine how local hospitals compare to others around the country. But the readmission figures don’t necessarily tell us only about hospitals. They tap into a larger story about whether a community can provide the services that make it possible to heal, and even live, at home—one of the key questions that’s part of the re-emergent aging beat.
What struck me as I ran through a list of hospitals that face large readmission penalties is how many are in regions where I’ve found long waiting lists for home-delivered meals available to those over age 60 under the Older Americans Act programs. Unsurprisingly, those regions are often poor. In the Shreveport, LA, region, where 14 hospitals face penalties and the typical penalty is above the national average, the head of the local aging council told me the meals program had a wait list of 200 to 300 people in 2012, even though it was serving more than 1,000 meals a day. In New Haven, CT, there were 269 people on the wait list for home-delivered meals in 2011, and that’s before the federal government sequester forced service cuts. Six hospitals in the New Haven area, and one in nearby Bridgeport, face above-average penalties for their readmission rates.
There are waiting lists for other OAA services, too, such as transportation and family caregiver support, the things older people discharged from hospitals need to stay at home. How close is the connection between these limits on community support and high readmission rates? That’s something we’ll need more reporting to know—and that’s where local journalists come in. Why not ring up the local meals-on-wheels programs and find out what’s happening? Interview some people who are waiting: They’ll likely put up a good front, but what are they really eating? Why are patients returning to the hospital? What do families have to say?
And Older Americans Act programs are not the only ones with long waits. In my earlier reporting I learned of an 84-year-old Baltimore man who was number 13,164 on a registry for Maryland’s Medicaid waiver program, which provides home and community-based services for long-term care—an alternative to returning to the hospital.
Then there’s the Community-Based Care Transitions Program, part of a larger initiative authorized by the Affordable Care Act designed to improve patient safety and reduce readmissions. It has gotten mixed reviews, though Erika Kelly, chief advocacy officer for the Meals On Wheels Association, says results from pilot programs her association has worked with that set up discharged patients with home-delivered meals show lower readmission rates. It’s a subject that could use a closer look.
Again, the broader point is that the data we’re getting can point to concerns beyond a hospital’s doors. When an elderly person can’t find the support she needs—whether food, care, or something else—in the community, she’s more likely to end up back in the hospital. Last year I interviewed a couple, both about 90, who were eking out a few dollars a day to pay for home-delivered meals as they sat on a wait list. Short on cash, they had been gradually cutting back their purchased meals further and further. “We’re not eating much of anything,” the man said. “I try the best I can. Sometimes, the best isn’t good enough.” Stories like that are an important part of the narrative about how our hospitals, and our healthcare system, are performing.
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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.