We got aggressive with some of the ACA, waiver programs, controlled spend, capitated systems and other novel entities in the preCOVID and early COVID time period.
By which I mean, we had methods to get old people into acute rehab from the ED in one business day with great success!
It actually made you feel like a good doctor. Some weak / falling nana would come in. You’d do your med trauma evaluation and find not much acute. But you’d talk to her and family and hear the issues. We had a pharmacy tech who would do a med rec for you (crazy polypharm sometimes!). Instead of discharging to doom or trying to make a “social admit” we’d drop them in ED obsv overnight, and first thing at 0800 PT, case management, SW and occasionally others would all assess the patient— and more importantly have the big talks with the family.
And a bunch we’d place to acute rehab. Some we’d send home with services. Some would just go home.
But it felt like you were doing good for people, and boy did patients / families like it. It also wasn’t much work from the Ed Md side, all the tough work was done by others.
But all the waiver programs have evaporated, everyone needs multiple inpatient midnights to qualify, hospital budgets have gutted PT/CM resources and we are so saturated with boarding we don’t have room to do this.
Sad.
