Mitigating The Impact of Community Hospital Closures on Older Patients

By Joy Stephenson-Laws, Founding Partner, Stephenson, Acquisto & Colman

Many hospitals, despite their best efforts to remain open, will need to make the difficult decision to close their doors. This is simply an unfortunate reality of today’s healthcare economics. Declining reimbursement and lower patient census have become the norm in many areas. Whether these closures occur in a rural community or a more urban setting, one group that inevitably finds itself disproportionately impacted are seniors. Seniors usually represent a significant percentage of the patient population affected by hospital closures.

Many seniors were born and raised in communities serviced by one local hospital and decided to spend their adult lives there. Others make the deliberate decision to move and retire in such communities. Now, with the closure of their local hospital, they may find themselves miles away from the nearest hospital.

Hospital closures in more rural areas can result in the nearest hospital being more than 20 miles away.  Given this situation, seniors understandably may feel somewhat concerned about and abandoned by the healthcare system when this happens.

It should not be surprising that various studies suggest that these concerns are well-founded. Hospital closures may negatively affect a community’s overall health as well as access to healthcare services. These negative effects are especially severe for seniors over 65-years-old.  They may choose to not seek alternatives to their previous providers due to cost, inconvenience and unfamiliarity with other hospitals or clinics that are out of their geographic “comfort zone.” Many may not even know how to go about making an appointment at an alternate location.

As such, routine wellness appointments, ongoing care for a chronic disease or necessary acute care are ignored or delayed, needlessly putting an elder patient’s health at risk.  This risk is even higher for elders who may be economically challenged.

Seniors who find themselves with a local hospital closure may also be concerned about where they will be able to find specialists such as gerontologists or urologists; where and how to get routine tests; and what to do in case of an emergency.  In addition to the medical aspects, older patients may also be affected by the loss of social aspects of the local hospital, such as seeing friends and family in the cafeteria during visits.

The central role that hospitals play in the lives of seniors will continue to increase as the population ages.  According to the U.S. Census Bureau, by the year 2050 there will be 83.7 million people in the United States who are 65-years-old or older.  That’s nearly twice as many senior citizens as there were in 2012.

Remaining providers should fill this healthcare gap

A provider who all of a sudden finds itself being the proverbial “only game in town” for healthcare services can benefit from this healthcare gap. From a population health perspective, doing so greatly reduces the risk of patients going without needed care.

There are also compelling operational, financial and community relations reasons for doing so. Paramount among these is that while patients 65 years and older represent around 13 percent of the U.S. population, they represent around 40 percent of hospitalized adults. They often are hospitalized three times as often as people between 45 and 65.  They also represent more than a third of healthcare related spending, according to the U.S. Centers for Medicare and Medicaid Services.  These percentages will increase as the population continues to age. On a per capita basis, estimates put healthcare spend at over $18,000 per person age 65 and older.  Some studies suggest that the per person spend on someone in their 90s could easily exceed $25,000 annually. Independent of the payor model, it is clear that this group represents a significant revenue source for providers.

How can providers attract senior patients?

While virtually all providers have some form of patient recruitment and retention programs in place, reaching seniors who may have lost trust in the healthcare system or are feeling “lost” after a community hospital closure requires a special approach.  This also holds true for seniors in general given their special needs and importance to a provider’s operations. When it comes to communicating with and building trust with seniors who have lost their local hospital, the following approach has been shown to be successful:

• Provide or subsidize transportation to your facility.  This has several benefits including making sure senior patients recognize that you’re really “not that far” away as well as allowing them to get to know your facility.
• Develop informative materials about what your facility offers.  Given that many, if not most, seniors are digitally-literate, offer this information via a variety of platforms.  Include interactivity as well begin a conversation and relationship with them.
• Use a variety of channels to communicate with this group.  Studies done after closures indicate that seniors found it helpful to learn about healthcare resources, including how to get to them, via a variety of sources such as the local newspaper and senior center.  Consider doing workshops on senior health topics to build community – and expand your patient database!

In addition, providers seeking to attract and retain seniors in their patient pool need to demonstrate (on an ongoing basis) some key benefits that are important to seniors. These include the following:

• Having specialists on staff who understand the special needs of seniors.  Just as pediatricians don’t view their patients as miniature adults, seniors are not just older versions of their younger selves.  Given that there are a declining number of board-certified geriatricians in the U.S., this could be a real plus.
• Recommending appropriate treatments or medications. Some doctors recommend treatment that may do very little for a senior patient, like recommending cholesterol medications to someone over 80 with no heart problems.  Cautious, evidenced-based treatment will go a long way to creating trust and confidence.
• Knowing what else to look for beyond the traditional wellness check-list during exams and visits.  This includes picking up on signs of isolation, depression, cognitive decline, lack of social support systems and self-care (such as remembering to eat enough and drink enough water).
• Providing opportunities to get more involved with the community.  A great idea is to encourage seniors to become volunteers at your facility.  In addition to giving them a way to give back in a meaningful way, it also strengthens the bond and relationship they have with you.  This, in turn, helps attract more seniors.

Some providers are very creative with building relationships with their senior community, including social outings and even “frequent healthcare” programs that reward seniors for taking better care of themselves via the provider’s facilities and services.  While you don’t necessarily need to go to such great lengths, getting closer to seniors and being better able to meet their needs when they may no longer have the security of a local community hospital will benefit providers and patients alike. It’s a decision you won’t regret.

About the Author

Joy Stephenson-Laws is the founder of Proactive Health Labs (www.phlabs.org), a national 501c3 nonprofit health information company that provides education and tools needed to achieve optimal health. In addition to her day-to-day leadership role with pH Labs, Ms. Stephenson-Laws is also the founding and managing partner of Stephenson, Acquisto & Colman (SAC), the health care industry’s premier litigation law firm established in 1989.  Her most recent book is Minerals – The Forgotten Nutrient: Your Secret Weapon for Getting and Staying Healthy, available through Amazon, iTunes and bookstores.