The Revolving Door: Re-admissions to the Hospital for the Elderly


Needless readmissions into the hospital account for an estimated $17 billion in wasted expenditures. This causes insurance companies and Medicare to impose penalties on hospitals. The results are further cuts in the quality of care received and higher bills for already overburdened elderly patients.

Readmissions place undue emotional burdens and stress…

Readmissions are so prevalent they are commonly referred to as the revolving door. How can effective programs be implemented to improve the level of care received and decrease re-admission rates in the country’s hospitals? How can the revolving door be stopped? It is not only an economic problem. Re-admissions place undue emotional burdens and stress on the readmitted elderly patient and his or her caregivers as well.

Efforts to Improve Readmission Rates for Seniors Have Fallen Short 

Efforts have been made, at the behest of many insurance providers, to provide incentives to reduce readmissions. The Centers for Medicare and Medicaid Services (CMS) took the lead by publicly reporting hospitals’ readmission rates in 2009 in hopes of decreasing the amount of readmissions. But public shaming did not work.

For the past ten years, readmission programs also have been developed and implemented to hopefully slow down the rate seniors are returning to the hospitals. A readmission program helps to identify common causes and which readmissions could have been avoided by better post-procedure discharge and better quality of care. Yet there has been a learning curve in developing and implementing these programs.

Also, there has been little financial advantage to hospitals to reduce readmission rates. There was no additional funding to pay for additional services such as discharge nurses or additional discharge steps, including sending discharge instructions to primary care physicians and caregivers. Furthermore, by reducing readmission rates, hospital administrators feared lost revenue from empty beds.

Thus, the “revolving door” kept spinning.

The Affordable Care Act is Affecting the Revolving Door

 In 2012, through the legislative act, financial penalties were imposed by the Medicare Hospital Readmissions Reduction Program (HRRP) on all general hospitals whose readmission rates were considered in excess. Penalties were aimed at hospitals with Medicare patients aged 65 and older with certain diagnoses that were associated with the unnecessary readmission rates. These penalties were a reduction in the amount of claims payouts. They get stricter for every year the rates do not decrease to acceptable levels.

While the legislation has made a difference, debate is strong that the effect isn’t as positive as some are claiming. There are structural problems that are becoming more and more evident. Hospitals serving a greater low-income population are receiving greater penalties. Despite a national overall reduction in readmission rates, from 19% to 17.8%, there is great concern that the HRRP readmission program is not treating hospitals fairly, especially those who naturally care for the most vulnerable and sickest populations. Critics claim better risk factor models should be developed and penalties adjusted to reflect the contrasting factors such as language and socioeconomic barriers that present across our nation.

Characteristics of a Good Readmission Program

Dr. Steven Fuller is a triple board certified physician with more than 25 years’ experience in the medical field, including work in hospitals, community programs, and assisted living facilities. He has streamlined his career looking for ways to make a difference in senior healthcare, particularly readmission issues. He says that a good readmissions program needs to contain the following components:

  • It must be cost effective.
  • It must make available online training resources to keep costs low and make it easier for busy staff to have.
  • The program must focus training on improving communication between doctors and patients.
  • It should train how to form a plan of action for identifying early health conditions in the caregiving setting.
  • Most importantly, it should promote a “person-centered”, not a “process-centered” approach to strengthen communication between patients/residents and attending physicians.

In the end, it all comes down to a greater collaborative effort between the healthcare systems, community living facilities, patients, and their caregivers. In addition to more effective readmission programs, there is a need for improved social services to help the elderly receive adequate access to resources for themselves and their caregivers. This will have a markedly positive impact on lowering the readmission rates of elderly people into hospitals.



Robert Wood Johnson Foundation. (2013). The Revolving Door Syndrome: Patients Returning to the Hospital Within Days of Being Released. Available at–patients-returning-to-hospital-with.html. Retrieved January 28, 2016.

Fuller, Steven. (2016). Readmissions in Assisted Living: Closing the Revolving Door. Available at Retrieved January 28, 2016.

Health Affairs. (2013). Medicare Hospital Readmissions Reduction Program. Available at Retrieved January 29, 2016.