Merrily Orsini's Thought Leadership

To Stay Healthy (and alive) Longer, Avoid Hospitalization, if Possible

We’ve certainly come a long way from the pre-Florence Nightingale days, when one of the earliest hospitals, the Hotel-Dieu in Paris, offered dark, unsanitary, poorly ventilated wards, multiple patients per bed (many of whom were infectious), and a mortality rate of more than 40%. And yet, we’re still struggling with complications related to hospitalizations – not the least of which is cost. And, in the Hotel-Dieu days, hospitalization was for the poor. The wealthy had healthcare delivered by their personal physician in the comfort of their own homes.

According to the just-released Trends in Hospital Inpatient Stays in the United States, 2005-2014 report, hospital costs are now “one third of healthcare expenditures,” with the inflation-adjusted mean cost per inpatient stay increasing over this time period by an average of 12.7% – from $9,500 to $10,900. Those covered by Medicaid or private insurance saw an even greater jump – as much as 16 – 18%. Actually, if you think about it, the increase for a span of 9 years is not such a great percentage increase. The increases are in the numbers. Although the percentage of hospitalization for the older age groups has decreased, the increase in the numbers is outweighing that drop as well. So, if we could prevent hospitalizations, we would save a boatload of money!

Other highlights of the report include:

  • Mental health/substance use accounted for nearly 6% of all inpatient stays in 2014, up 20.1% from 2005.
  • Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled. TRIPLED!
    • People who are already in the hospital for something else, such as a surgery, are at a higher risk of developing septicemia.
    • Secondary infections can occur while in the hospital. These infections are often more dangerous because the bacteria may already be resistant to antibiotics.
  • Nonspecific chest pain and coronary atherosclerosis decreased by more than 60% from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.

And of particular interest to me, as I mentioned above: the report uncovered a substantial decrease between 2005 and 2014 in the rate of hospital stays in the elderly – more than 20% in the over-65 age bracket. No data to back up my suggestions, but it seems to indicate that either older adults are taking better care of themselves, that because of the reputation of infections in hospitals folks are avoiding hospitalizations, if possible, that the provision of home care is working to delay or prevent hospitalizations, what we now call pre-acute care – or a combination thereof. With the significant risks to hospitalized older adults (delirium, bed sores, falls, serious and sometimes deadly infections, just to name a few) it’s crucial to stay OUT of the hospital; and thankfully, it seems we’re headed in the right direction.