Sacramento Bee

By Aurelio Rojas - Bee Capitol Bureau
Published 12:00 am PDT Thursday, October 4, 2007

As an only child, Jackie McGrath cared for two elderly parents with dementia -- and her experiences with hospitals were as eye-opening as they were frustrating.

When her parents were discharged, McGrath told a legislative panel Wednesday, hospitals failed to adequately assess their after-care needs.

Instead of returning them to the small board-and-care facility where they felt at home, they were steered to costly nursing homes -- until she intervened.

"Virtually any frail senior will be viewed by doctors and (hospital) discharge planners as nursing care eligible," said McGrath, policy director for the California chapter of the Alzheimer's Association.

The joint hearing of the Assembly Aging and Long-Term Care Committee and the Assembly Health Committee focused on the discharge plans that hospitals provide to patients before releasing them.

Experts told the panel that as health care costs have risen, hospital stays have shortened and patients are increasingly likely to leave with inadequate after-care plans and end up back in the hospital.

Barbara Biglieri, policy director for the California Association for Health Service at Home, said an estimated 25 percent of patients will return to the hospital within the first week after discharge, and 56 percent within three weeks.

The result, say researchers and care providers, is a system that wastes money while restricting the choices of older adults and people with disabilities.

Home support health services cost the state far less than care in hospitals or skilled nursing facilities. But, the panel was told, state Medi-Cal and federal Medicaid regulations routinely steer patients to institutional facilities and erect barriers for those seeking to return to their homes.

With the number of Californians age 65 and older expected to double from 3.5 million to more than 7 million by 2050, experts say those rules need to be changed for the state to manage the cost of caring for its aging population.

California hospitals already discharge more than a million patients each year over the age of 65, according to the federal Centers for Disease Control and Prevention.

"Better discharge planning can mean the difference between a patient getting better, getting to stay home, or getting hospitalized again," said Assemblywoman Patty Berg, the Eureka Democrat who chairs the Aging and Long-Term Care Committee.

But Nan Brasmer, president of the California Alliance for Retired Americans, said most hospitals don't help patients access support services to recover at home.

"Hospitals have too few social workers who have many, many other assignments," Brasmer said. "Discharge planning is often at the bottom of tasks that they are expected to do."

Shelley Johnson, a registered nurse who represented the California Hospital Association at the hearing, testified the industry standard is a manageable 20 patients for each caseworker.

Johnson said at NorthBay Healthcare, the two-hospital system in Solano County where she works, caseworkers "work with patients, families and care givers to develop a plan that customizes their medical needs (and) their social and financial resources."

"We will often spend hours working on one patient while managing other patients' needs," Johnson said.

Lynn Daucher, director of the California Department of Aging, said the state is developing a plan to improve elderly patient care.

"California has received a lot of federal grant money, in drips and drabs, that will help us with these transition issues from hospital and nursing facilities," Daucher said.

Toby Douglas, a deputy director of the state Department of Health Services, said his department is also developing a "coordinated care management pilot program."