THERAPY-Magazin
A critical look at geriatric hospital rehabilitation
Jakob Tiebel
Business Owner, N+ Digital Health Agency
According to recent studies, elderly patients with multiple conditions often do not receive optimal care in hospitals. The number of geriatric patients with multiple clinical patterns in hospitals rose from 1.1 million to 2 million between 2006 and 2015 in Germany alone. Increasing numbers of those affected receive special rehabilitation treatment in clinics, which, due to the complexity of care, seems to be considerably more expensive than normal rehabilitation, but not necessarily more effective.
The consequences of demographic change are omnipresent. In Europe and other industrialised countries around the world, the number of patients aged 70 and over in hospitals is increasing rapidly.
The number of patients aged 70 and over in hospitals is increasing rapidly.
Over the last ten years, the number of geriatric patients rose by around 80 percent. In Germany alone, there has been an increase of around one million treatment cases, according to a recent health insurance study. Forecasts predict that “generation 70 plus” will experience at least another 50 percent increase by 2050.
Geriatric medicine is a relatively new discipline dedicated specifically to elderly patients whose health and independence are often impaired by not just one, but several acute and chronic diseases.
Patients are cared for by multi-professional teams, including specialists in neurology, internal medicine and geriatrics, as well as staff trained in nursing, physiotherapy, occupational therapy, speech therapy, social and care counselling, nutrition counselling, psychology and pastoral care. Together, caregivers work towards recognising functional disorders that impact everyday life, taking physical, psychological, social and spiritual aspects into account, and then treating these disorders in a targeted manner. Unfortunately, in reality, care is not always adjusted to the individual needs of patients. Hospitals today seem to focus primarily on one thing: money.
Geriatric medicine is a relatively new discipline dedicated specifically to elderly patients whose health and independence are often impaired by not just one, but several acute and chronic diseases.
Patients are cared for by multi-professional teams, including specialists in neurology, internal medicine and geriatrics, as well as staff trained in nursing, physiotherapy, occupational therapy, speech therapy, social and care counselling, nutrition counselling, psychology and pastoral care. Together, caregivers work towards recognising functional disorders that impact everyday life, taking physical, psychological, social and spiritual aspects into account, and then treating these disorders in a targeted manner. Unfortunately, in reality, care is not always adjusted to the individual needs of patients. Hospitals today seem to focus primarily on one thing: money.
Hospitals today seem to focus primarily on one thing: money.
With the introduction of diagnosis-specific per-case flat rates and fixed daily treatment charges, the requirements for successful hospital management have increased considerably. After several decades of very little change in the healthcare system, change has now, in many ways, become the only remaining constant. The abolition of the cost-price principle and the introduction of per-case flat rates have meant that economic management, and therefore well-planned occupancy management, have become key topics for many hospitals.
Many clinics have already been forced to close their doors in recent years due to a drastic increase in competition and price pressure. In terms of operating results, almost every other hospital is in deficit.
The total costs incurred are often higher than the revenues that can be obtained from per-case flat rates. Short-term revenue increases are created through volume expansions and the negotiation of additional fees. Cost reductions are achieved primarily through a reduction in staff deployment and use of technology, as well as by shortening hospitalisation periods.
Many clinics have already been forced to close their doors in recent years due to a drastic increase in competition and price pressure. In terms of operating results, almost every other hospital is in deficit.
The total costs incurred are often higher than the revenues that can be obtained from per-case flat rates. Short-term revenue increases are created through volume expansions and the negotiation of additional fees. Cost reductions are achieved primarily through a reduction in staff deployment and use of technology, as well as by shortening hospitalisation periods.
Multidisciplinary hospitals can ensure optimal care.
However, these measures are not very promising in the long term. Instead, a restructuring of care processes and an optimisation of clinical treatment paths seems to be necessary in order to successfully combine “values and value” – values from an ethical and moral perspective, and value in the sense of goal-oriented economic activity. Unfortunately, such strategic approaches are rarely encountered in reality. Far too often, hospital management plays the role of the “fire brigade”, instead of investing in effective long-term “fire prevention” measures.
This situation can be exemplified by the care procedure for one of the most common injuries suffered by older people: femoral neck fracture. In most cases, the cause is a fall sideways onto the hip, or onto the leg when extended or spread. The hip fracture causes the affected person a lot of pain, and as a consequence, the leg can no longer be actively moved. The treatment of choice is surgery. Nevertheless, a drastic consequence in many cases is permanent dependency on care,
This situation can be exemplified by the care procedure for one of the most common injuries suffered by older people: femoral neck fracture. In most cases, the cause is a fall sideways onto the hip, or onto the leg when extended or spread. The hip fracture causes the affected person a lot of pain, and as a consequence, the leg can no longer be actively moved. The treatment of choice is surgery. Nevertheless, a drastic consequence in many cases is permanent dependency on care,
since the fracture begins a vicious circle of immobilisation and lack of activation. Those affected barely dare to get out of bed because they feel they can no longer rely on their bodies. They are very afraid of falling, and develop avoidance strategies. The resulting lack of exercise leads to a progressive decline in strength, endurance and mobility. This leads to more falls and complications such as thrombosis and pneumonia.
This can be prevented if the right therapy is provided after the operation. It is crucial that patients are made fit for everyday life again in as rapid and targeted a manner as possible. This usually happens as part of a subsequent rehabilitation measure. As geriatric patients are often not stable enough to be transferred to subsequent rehabilitation due to their pre-existing conditions, further treatment takes place in the hospital, as part of a geriatric early rehabilitation complex treatment programe (geriatische frührehabilitative Komplexbehandlung, GFKB) created specifically for this purpose. The GFKB aims to compensate for the unstable transfer of geriatric patients from acute treatment to rehabilitation.
This can be prevented if the right therapy is provided after the operation. It is crucial that patients are made fit for everyday life again in as rapid and targeted a manner as possible. This usually happens as part of a subsequent rehabilitation measure. As geriatric patients are often not stable enough to be transferred to subsequent rehabilitation due to their pre-existing conditions, further treatment takes place in the hospital, as part of a geriatric early rehabilitation complex treatment programe (geriatische frührehabilitative Komplexbehandlung, GFKB) created specifically for this purpose. The GFKB aims to compensate for the unstable transfer of geriatric patients from acute treatment to rehabilitation.
Increasing age-related multimorbidity is creating a need for these kinds of treatment procedures. The justification given for integrating this service into the per-case flat rate system is that the multimorbidity typical of geriatric patients becomes part of the case definition, and the provided services therefore explicitly correspond to it. This means that geriatric rehabilitation in hospital includes complex services that are intended to justify flat-rate care fees. And that is exactly how it works – clinics can charge correspondingly higher fees if they provide geriatric patients with inpatient GFKB treatment for at least two weeks following acute treatment. The service providers thus promise the cost bearers that they will optimally resolve the treatment backlog resulting from demographically induced multimorbidity, following the principle of economic efficiency. The GFKB certainly has potential, both in terms of social and benefit law, as an early rehabilitation programme in hospitals that is compatible with the per-case flat rate system and is secured as a complex treatment.
But a recent study reveals the programme’s weaknesses. Around 47 percent of patients become dependent on care after hospital rehabilitation, while this number is significantly lower – only 40 percent –
But a recent study reveals the programme’s weaknesses. Around 47 percent of patients become dependent on care after hospital rehabilitation, while this number is significantly lower – only 40 percent –
Clinics that want to secure their future in the long term must start making plans now
after traditional rehabilitation. Nevertheless, the number of complex treatments rose sharply in recent years. The proportion of patients who are discharged from the hospital after exactly 14 days is particularly high, which could be due to the financial reward. For example, complex treatment following a femoral neck fracture costs around €4,100 after 14 days of treatment. This is about €1,000 more than would be charged for classic rehabilitation. The question therefore arises as to whether the care is truly primarily focused on the individual needs of patients, or whether financial incentives play a larger role.
The possibilities offered by the GFKB should not be fundamentally called into question, however. It is clear that multidisciplinary hospitals with appropriate specialisation can indeed guarantee a good standard of care.
In addition, medical care today demands a high degree of adherence to ethical, moral and social values, and this must also remain financially viable through good business management.
In future, general conditions will lead to the establishment of further competitive elements in the healthcare market, and the fees charged per case will continue to decrease. Clinics that want to secure their future in the long term must start making plans now in order to remain competitive in the future. Economising alone is certainly not a sustainable formula. Instead, clinics will need to organise a fundamental change, and optimise processes relevant to value creation in such a way that they contribute equally to optimal patient care and to economic results. And last but not least, the motto “prevention is better than cure” applies to geriatrics just as much as any other field – it is important to focus on preventive measures such as avoiding falls.
The possibilities offered by the GFKB should not be fundamentally called into question, however. It is clear that multidisciplinary hospitals with appropriate specialisation can indeed guarantee a good standard of care.
In addition, medical care today demands a high degree of adherence to ethical, moral and social values, and this must also remain financially viable through good business management.
In future, general conditions will lead to the establishment of further competitive elements in the healthcare market, and the fees charged per case will continue to decrease. Clinics that want to secure their future in the long term must start making plans now in order to remain competitive in the future. Economising alone is certainly not a sustainable formula. Instead, clinics will need to organise a fundamental change, and optimise processes relevant to value creation in such a way that they contribute equally to optimal patient care and to economic results. And last but not least, the motto “prevention is better than cure” applies to geriatrics just as much as any other field – it is important to focus on preventive measures such as avoiding falls.
Cycling
Fachkreise
Gait
Produkte
Software
Standing & Balancing
Stationäre Rehabilitation
Therapy & Practice
THERAPY Magazine
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Jakob Tiebel studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of Native.Health, an agency for digital health marketing.
References:
- Albrecht M, Töpfer A (2017). Handbuch Changemanagement Krankenhaus. 20-Punkte Sofortprogramm für Kliniken. 2. Auflage, Springer Verlag
- Augurzky B et al. (2017). Krankenhausreport 2017. Schriftenreihe zur Gesundheitsanalyse. Band 4, RWI – Leibniz-Institut für Wirtschaftsforschung.
- Ernst F (2012). Neue Entwicklungen in der Krankenhausbegutachtung. Geriatrische Frührehabilitation im Spannungsfeld zwischen Krankenhaus- und Rehabilitationseinrichtungen. DGSMP-Jahrestagung.
- Geissler A (2013). DRG-Systeme in Europa. ZVEI-Jahrestagung 2013. WHO Collaborating Centre for Health Systems, Research and Management.
- Wrobel N (2008). Die Demografie verändert die Grundversorgung. Die geriatrische Komplexbehandlung gehört in jedes Krankenhaus. f&w: 2
Related contents
Find related exciting contents in our media library.
This is not what you are searching for? Knowledge
Meet our specialists.
Are you interested in our solutions? Schedule a meeting with a Consultant to talk through your strategy and understand how TEHRA-Trainer can help you to advance rehabilitation.