The Care Transitions Project is a new Medicare program intended to reduce the number of people who are readmitted to hospitals shortly after their discharge—and ultimately save the agencies money. Presently, many nursing homes and assisted living facilities are faced with the difficult task of caring for people who may be recovering from an injury or disease that required hospitalization. In some cases, staff in the new environment are not trained on how to provide proper follow-up treatment.
The lack of staff training can translate to more visits to the hospital. By CMS's estimates, 20% of hospital patients get readmitted within 30 days of their discharge to a nursing home or assisted living facility. CMS estimates up to 75% of the readmissions are preventable with proper treatment in their discharge setting.
The program identified as the Care Transitions Project will be tested in 14 preselected communities. State officials will help facilities create programs to provide necessary care outside of a hospital setting. The program will begin shortly and will remain in place through the summer of 2011.
I hope this program has sufficient safeguards to ensure the safety of new admissions to nursing homes and assisted living facilities. Many people are at heightened risk for injury and disease shortly after their admission because their medical condition is unstable and the facility remains unaccustomed to their medical needs. Safeguards should be in place to ensure those who really need hospital services receive the care they require.