‘Bed-blocking’ as a signal failure of transitional care. Here is a term that may be unique to the UK, but not the problem: older people who cannot be discharged after an illness because there is no plan and no suitable place for transitional care and/or a safe return home with care. According to the Guardian, the term originated among UK healthcare managers and economists as early as the late 1950s as a marker of system inefficiency. The writer, Johnny Marshall, director of policy for the NHS Confederation, correctly notes that it should be a marker of “(a) system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home” and that unfairly blames the patient. He gives examples of programs across Britain with home assessment and care, particularly for older people post-fall injury, that reduce or eliminate hospital days.
In the US, transitional care is pointing to a blend of home care tech/services. Some of the indicators for LTC support that Laurie Orlov points out in Tech-enabled home care — what is it, what should it be?:
- Assisted living growth is flat as this past weekend’s open can of soda–housing is chasing residents (though cost doesn’t seem to be following the usual supply/demand curve), the average resident is 87 years old and staying 22 months, and their net worth can’t afford present AL
- There’s a huge and growing shortage of home care workers for an ever-increasing number of old and old-old
- Yet finally big investment is taking place in tech-facilitated home care locating and matching: Honor.com, Care.com and ClearCare–a total of just under $150 million for the three
But can technology–front and back end–make up for the human shortage? And there’s a value in wearing the Quantitative Self hat here. Beyond the very large job of integrating functions, ADL assistance, personal care and a social experience/network, we also need quantitative and qualitative health data for nearly all these older people, which leads us back to transitional and chronic sub-acute care. Telehealth (and telemedicine) can and must be part of that ‘right package of care’ that allows a person to stay home longer. It also provides a rationale (at least in the US payment system) for assistive care. (And round and round we go….)