There are about a million elderly people hospitalized alone who stay at least a week longer than necessary in the ward because they do not have assistance at home, keeping the beds occupied and affecting the costs of the structures. There are about one million hospitalizations in internal medicine and half of the hospitalized, therefore 500 thousand, are over 70 and have no one. 50%, according to an estimate by Fadoi (the scientific society of internal medicine), stays at least a week longer than necessary: this is 250,000 elderly people every year. But broadening our gaze to the total number of hospitalizations (5 million in all) it can be estimated that there are at least one million in all wards.
Every year there are a total of over 2 million days of improper hospitalization only in internal medicine due to the difficulty in discharge of the elderly who do not have family support or resources for assistance at home. This is the weight that unduly falls on public health due to the shortcomings of the social assistance system, but also of the territorial health services that are poorly equipped to take charge of these patients. A survey conducted in 98 facilities by Fadoi indicates that more than a week passes from the date of discharge indicated by the doctor to the actual exit date in 26.5% of cases, from 5 to 7 days in 39.8% of patients, while another 28.6% stop for two to four days more than necessary. 75.5% of elderly patients remain in hospital improperly because they have no family member or caregiver able to assist them at home, while for 49% there is no possibility of entering an RSA. 64.3% extend hospitalization beyond what is necessary because there are no intermediate health facilities in the area while 22.4% have difficulty activating home assistance. And all this has a cost for the NHS of around one and a half billion a year.
Considering that hospitalizations in internal medicine wards are around one million a year and that at least half of these are over 70 and then taking into account that well over 50% of these extend their hospitalization by a week on average beyond medical needs , in total there would be 2.1 million excess days of hospitalisation. A number which significantly affects the clogging of hospitals and which, considering the average cost of a day of hospitalisation, equal to 712 euros according to OECD data, make a total of one and a half billion a year of expenditure that could have been invested in real health care. In the Internal Medicine departments – but the situation does not change much in the other departments – more than half of the over 70s are in 87.8% of the structures. There are also many people over eighty, who are over half in 17.3% of the structures, between 40 and 50% in 20.4% of cases, between 30 and 40% in 24.5% of wards.
However, do not think of internal medicines as parking lots for the elderly alone. Those who are hospitalized are in fact complex patients, who in 80.6% of cases still require more than seven days of hospitalization to be adequately treated, so much so that they require a high intensity of care in 28.6% of cases, the average for 69.4%. The problem is that when the same doctor arranges for the patient to be discharged, that date never corresponds with the actual discharge date. In fact, these last for more than a week in 26.5% of cases, from 5 to 7 days in 39.8% of patients, while another 28.6% stay longer than necessary for two to four days. “We experience the need to take on social problems that end up unduly weighing on hospitals every day”, comments Francesco Dentali, who became the new President of Fadoi on 1 January. For the outgoing president of Fadoi, Dario Manfellotto, “recipes such as Community Houses and Community hospitals are old, models that we have already defined and experimented with but which often do not work and we have seen this for example with Covid”.
