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The sick versus the 'not sick' in long-term care

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Elizabeth Newman
Elizabeth Newman

Of the many intriguing philosophies offered up at the Long Term Post Acute Care Health IT Summit this week, one that stuck with me was from Andrey Ostrovsky, M.D., the founder of Care at Hand. (He's also a pediatric resident at Boston Children's Hospital, and my lunch table had a debate as to whether he ever gets to sleep).

He said that physicians like himself are taught how to work quickly doing medical procedures such as intubation, which is reflective of the financial structure of hospitals and the demands on a physician's time.

“We don't take time to listen to a patient's story,” he said bluntly. (Let's not even discuss how much worse that can be with surgeons, who tend to be trained to cut rather than talk.) Even nurses, Ostrovsky noted, tend to operate in healthcare settings as dividing patients into “sick/not sick.”

This may be especially true in an acute care setting, but it led me to realize how easy it would be for a senior to fall into a gap related to their care transitions. To start, as Dr. House used to say, “Everybody lies.” Two, it's not uncommon for seniors to be able to hide cognitive problems. Three, many seniors fear admitting a problem will land them in a nursing facility, rather than getting to go home.

When thinking about care transitions, it's often been tasked to a nurse, social worker or discharge planner to try to catch those seniors before they end up in the emergency room again. The problem is, of course, time, money, and a lack of data around how well this is working in preventing hospital readmissions.

Ostrovsky suggests a new way, which is community health coaches using a mobile system to ask questions based around the Coleman care transition model. The data goes to a nurse case manager, but Ostrovsky makes a good argument for why there should be more community health coaches empowered with data. These employees, who may have a starting salary of $30,000, are more likely to live in the same community, have the same educational level, have the same language and similar backgrounds as the patients. It leads to them being better at empathy, and connecting with the patient in a way that can hopefully keep that person out of the hospital.

The advantage of the mobile technology, additionally, is that these community health workers “can learn on the spot,” and intervene faster, Ostrovsky noted.

A lot of people in long-term or post-acute care tune out when they hear words like “home” or “community,” especially if it's the phrase “community health worker.” But no matter what you call it, there is a value for healthcare entities to have employees using new technology to prevent seniors from bouncing back to a hospital.

Elizabeth Newman is Senior Editor at McKnight's Long-Term Care News. Follow her @TigerELN.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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