Refuse Care At Your Own Risk

A recent study shows that as many as 28% of all seniors refuse care after a hospitalization for an acute injury or illness. The study revealed that those refusing care were more likely to be younger, to have been admitted to the hospital from their homes, to have some higher education, and to have less complex medical situations than those who accepted post-acute care. Yet these factors, all which would logically indicate a greater willingness to accept recommendations of a medical professional, actually result in refusal to accept the advice to establish post-acute care. Reasons seniors refuse post-acute care vary from concerns about cost to a misunderstanding of the care provided, to fear of it leading to institutional care, and just plain stubbornness. Regardless of the reason for refusal, the refusal to accept home care results in a higher likelihood of hospital readmission and more severe injury to the senior. In fact, almost a third of those who refused post- acute care were readmitted to the hospital within 60 days of discharge and were twice as likely to be readmitted to the hospital as those who accepted care.

The home care available after a hospitalization is often paid for through Medicare and Medicare supplements and results in very little out-of-pocket expense. This factor appears to not be well communicated or understood by many, especially those who are recommending the care and arranging the referral. Even if the care is not completely paid for through insurance, the cost to the senior is worthwhile, since seniors refusing care are more likely to be readmitted to the hospital and ultimately end up with less quality of life than those who accept the care.

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In addition to a misunderstanding of cost, there is often confusion as to the type of care provided after a hospital stay. The home care provided as part of the Medicare rehabilitative benefit includes intermittent skilled care from a nurse, a physical therapist or a speech therapist which typically only lasts four to six weeks after a hospitalization, with a nurse visiting several times a week. The care provided is not long-term custodial care or “babysitting” as one senior described it. This misunderstanding about services is one reason that many cite as the prevailing reason seniors refuse care. The senior often wants to remain independent in their home and fear that the post-acute home care erodes their independence. However, the post-acute home care is designed to help seniors regain their independence. One senior interviewed as part of the study said that he “didn’t need a babysitter,” and that’s why he refused care despite an earlier promise to his daughter that he would accept care.

Another reason cited for refusing care is “my spouse will take care of me.” However, when spousal caregivers are consulted, they often confess they cannot provide the level of care and assistance that the skilled nurse can provide and often get worn out from providing care. This may be one explanation behind hospital readmissions. If post-acute care services are refused in favor of a caregiver at home, and the caregiver cannot provide the necessary care, then the individual is readmitted due to a lack of needed care.

Regardless of the reason, statistics show that receiving post-acute care after a hospital stay reduces the risk of another hospital admission. Fully understanding the care to be provided and the reasons for it, as well as overcoming stereotypes and harbored misconceptions, may be a key to accepting care when offered and staying at home and independent longer.



Kit Kat

Ask Kit Kat – Perceptive Canines

Hook Law Center:  Kit Kat, what can you tell us about canines and their extraordinary ability to perceive danger to humans and how they often intervene to save lives?

Kit Kat:  Well, canines are indeed remarkable! There has been case after case reported in which the family pet has saved the lives of its family members. A Connecticut case in 2012 had a happy outcome when the family pet woke up the parents to alert them that an infant child had stopped breathing. The parents intervened in time, and the little girl survived. In Atlanta in 2014, a German shepherd saved 2 family members during a road-rage incident. He jumped in the line of fire, protecting a lady and a child. The dog died of his injuries. In another case, Polo, the family dog, lay on top of eight-month old Viviana, keeping her safe during a devastating fire. The girl survived, but Polo did not.

So what we lay people have long observed is now being studied by scientists. There is preliminary data to verify that dogs indeed possess some unusual abilities of perception and empathy. What is more, they are often motivated to act on these feelings! Scientists in Europe and the United States are conducting investigations on this subject. At Duke University’s Canine Cognition Center, scientists like Brian Hare examines the phenomenon of bonding. He says, ‘What is extraordinary is that dogs are so close to us—and so much a part of our lives—that they sometimes happen to be in the right time and place, and whether intentional or not, manage to save lives.’ He also talks about the bond between people and dogs. He says it is similar to the parent-child bond. When either party gazes into the eyes of the other, a hormone called oxytocin is released. It makes both parties relax and feel at ease. He says, ‘Dogs have basically hijacked this pathway that was meant to be between us and our kids. So when your dog is just staring at your for no apparent reason, they don’t necessarily want anything. They are just hugging you with their eyes.’

Other researchers have used MRIs to study dogs’ brain waves as they react to human voice cues. The human voice stimulates the dogs’ brain to light up, if the vocalizations are positive. Others studies have revealed dogs can distinguish differing facial expressions.

More study will continue. But the positive interactions between man’s best friend and his human companion are well documented. Occasionally, there are negative encounters between the two species, but that is often the result of abuse by the human. We are only now beginning to appreciate the depth and breadth of the canine mind. Science is enabling us to unlock these secrets.


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