Reducing Readmissions: New Guideline Aim to Help Serve People with IDDs

Readmission rates among those with intellectual and development disorders, mood disorders and psychiatric conditions represent some of the highest hospital readmission rates in the country. According to the Healthcare Cost and Utilization Project, readmissions following discharge for mental health or substance abuse conditions stood out at nearly 15 percent in 2012, the most recent year for which data are available.

Unfortunately, the problem only grows worse when considering those with IDDs, including autism spectrum disorders (ASDs). Specifically, children with ASDs or IDDs make up to 20 percent of children hospitalized in psychiatric facilities in the U.S., reports Autism Speaks. However, the rate of readmission may account for this admission surge, and new guidelines may help reduce the rate of readmissions.


What Are the New Guidelines?

The new set of guidelines is geared toward reducing the incidence of readmission for children with intellectual disabilities, including autism. These guidelines were created in response to a growing epidemic of not fully addressing issues during the time of hospitalization. Some may argue readmission is a minor issue. However, high readmission rates can directly influence Medicare and Medicaid payments, reports the Becker’s Hospital Review.

The new guidelines include four critical steps mental health caregivers, therapists and social workers need to take before discharging children and adolescents from psychiatric facilities. These guidelines include the following:

  • Screen for any other medical issues that could be contributing to the emotional or behavioral health problems. For example, is physical pain from an injury contributing to increased aggression?
  • Evaluate the individual’s communication and sensory challenges. For example, does the person have impaired ability to speak, or do they suffer from impaired hearing?
  • The treatment setting needs to be conducive to those with ASDs or IDDs. In other words, nonverbal communication methods should be top priorities when caring for those hospitalized.
  • All staff needs comprehensive, updated training on caring for those with ASDs and IDDs. Every staff members needs to know how to work with those with IDDs, including de-escalation tactics and strategies for social learning. Adequate training is the most important practice included in these new guidelines.


Why Are the Causes of Readmission?

The new guidelines aim to reduce the costs associated with readmitting and caring for those with IDDs or ASDs. According to MedicalXpress, up to 27 percent of all hospital readmissions could be prevented through the use of thorough treatment and screening tactics before the time of discharge. However, part of the problem with high readmission rates involves insufficient need for initial admission.

For example, readmission rates are the direct result of an original admission to the hospital that was either premature or unwarranted. If an emergency department admits a person to the hospital before an actual crisis had emerged, the risk of a subsequent readmission increases.

Another study, published in PLOS ONE Journals, indicated readmission rates among those with behavioral or intellectual disabilities may be as high as 69 percent nationally.

Readmissions may be the result of insufficient communication and goal planning at the time of discharge. If a person or a person’s family members expect unrealistic progress after admission, he or she is more likely to seek readmission if these goals are not met. As a result, discharge planning needs to be more thorough in creating realistic expectations for recovery and mental health stability.


Consequences of Readmissions

As mentioned previously, high readmission rates result in higher costs for respective psychiatric facilities. The financial penalties assessed by Centers for Medicare and Medicaid Services are expected to reach $528 million in 2016. Yet, the data used in determining these penalties continues to lag behind by four years. As a result, the true cost of today’s readmissions may not be seen until 2020. Therefore, the only viable solution is to take all actions possible to reduce readmission rates immediately.

There are other risks associated with high readmission rates. The greater number of admissions to psychiatric hospitals implies an inability to get proper care for all co-occurring mental health conditions, including those with IDDs. Consequently, those who fall into this loop may be at an increased risk for engaging in risky behaviors in an effort to “feel better.”

For example, those who do not receive positive end results may be more likely to turn to street drugs for relief of anxiety, depression or other symptoms of ASDs and IDDs. As a result, the risk of being exposed to violent crime after multiple hospital readmissions increases. In some cases, the time between the initial discharge and violent experience may be up to 4.2 years, which reiterates how the costs of readmissions in 2016 may not be truly felt for several years.   


Going Forward

The statistics on how severe readmissions may be are disheartening. But, they are actually a call to action. Start working with your team to create redundancies at the time of discharging individuals with IDDs, ASDs or other behavioral and mental health problems. This will help to prevent them from “falling through the cracks.” You also need to make sure discharge processes are attainable.

For example, a person cannot realistically attend follow-up appointments if transportation is not available. As a result, you may need to arrange transportation services for them, or you may want to explore financial programs to ensure co-pays do not deter them from continuing care.

These new guidelines were created specifically for children with intellectual and developmental disabilities, but they are applicable to all age groups. The people you serve may not have the wherewithal to express their concerns at the time of discharge, but you have to be their voice. You have the power to change their lives by ensuring all of their needs are met before discharging them from mental health facilities. 

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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