Hospitals Are Out (But You Already Knew That)

Posted by Meg LaPorte

Dec 15, 2015 9:08:34 AM

Hospitals are out and community alternatives are in, according to Bill Thomas, MD, aging guru and Harvard-trained geriatrician, who was at University of Maryland Baltimore County recently to share his opinions on long term care, ageism, and the word “continuum,” among other things.

After declaring himself a nursing home abolitionist, Thomas was quick to note that he bears no ill will toward owners, operators, or others who work in such places—he simply wants to abolish institutional models of care.

Dr. Bill ThomasThis assertion is not a new one for Thomas, who had just finished his Age of Disruption tour of 35 U.S. cities. He began his career as a nursing home medical director in New York some 30 years ago, where he encountered poorly run facilities and painfully lonely and isolated residents. Since then, he has founded the Eden Alternative and Green House models of long term care, which eschew models that adhere to institutional dictates.

However you may feel about Thomas' views, he is a force to be reckoned with when it comes to holding sway among long term care professionals. His standing as an aging influencer (a title bestowed upon him by both and The Wall Street Journal) is undeniable. He is credited by most to be the founder of the culture change movement in nursing homes, and his many followers (nearly 7,000 on twitter and thousands between his Facebook page, blogs, and books) believe him to be a bit of a savior in the field of aging services.

The informal gathering enabled Thomas to wax extemporaneously from his “notebooks of thought” on topics such as aging, grief, and hospital care. Yes, that’s hospital care. The good doctor believes that the law responsible for Obamacare is doing a fine job of steering money away from hospital beds and toward outcomes.

How so? For one, he says the Affordable Care Act (ACA) is creating, slowly and imperfectly, “a movement away from a system where the money follows the bed to one where money follows the risk,” he says. What’s emerging, he adds, are populations of people that become enrolled in an organization or system that takes responsibility for those people and those outcomes (a la accountable care organizations).

“All of the sudden,” says Thomas, “heads in beds is not a winning strategy.” He confessed that he spent years of his career doing the best he could to make a flawed nursing home model work. “But now, provisions of the ACA are changing that far more than I ever did."

Connected to this issue, Thomas noted, is something known as post-hospital syndrome—when someone goes into a hospital and comes out much worse off due to a lack of movement resulting in loss of balance and muscle mass, among other things. 

“What happens in a hospital,” Thomas said, “is they treat a presenting complaint and when it’s been adequately treated, you are discharged. They don’t help you heal; the docs treat the numbers, and not the person.”

So, what is the antidote to this? Thomas posits the following: Move Eat Sleep and Heal, or MESH. He believes that hospitals and the entire health care system have been doing it wrong by focusing on chief complaints and diagnoses when they really need to focus on MESH.

“We spend billions of dollars where it’s virtually guaranteed that Medicare patients will not heal,” he says. “The slope [of decline]Hospital_photo.jpg is of our own creation. We manufacture disability, frailty, weakness, and we create it on a massive scale.”

In short, Thomas says he would like to “free America’s elders from its hospitals.” The real conversation, he adds, is with the payers and with the people who will set up new and different networks that keep people out of hospitals.

The corollary to this, Thomas notes, is to “create a rich set of community-based alternatives that work for people. Get the people who are in hospitals out of hospitals, don’t put them in the nursing home, put them in a place in a neighborhood in a community where they can get MESH care,” such as their homes.

A future post will examine why Thomas wants to wage war on the word “continuum.”

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Topics: Aging, Hospitals