Two reports released by the New York-based United Hospital Fund (UHF) charge that hospital patients face substantial challenges when seeking the post-acute care option that can best meet their care needs after major surgery or a serious illness. The reports are the next two installments in UHF’s four-part “Difficult Decisions” series, based on a year-long analysis of post-hospital care. The review was funded by the New York State Health Foundation (NYSHealth).
UHF’s report, The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers, released on January 9, 2019, is based on discussions with patients and family caregivers about their experience selecting a skilled nursing facility during the hospital’s discharge planning. Authors, Carol Levine, MA, director of UHF’s family caregiving initiatives and Kristina Ramos-Callan, MA, a UHF program manager, discovered that the patients and their families felt rushed and stated they had little say when choosing a post-acute care facility.
Vivid Accounts of “Limited Choices” and “lack of Information”
“We heard vivid stories from our participants about the limited choices they felt they had, the lack of information about the quality of care at different facilities, and what they perceived as the failure of hospital staff to prepare them for the experience of being in a nursing facility, not a hospital,” said Levine, in a statement announcing the study’s findings. “In the end, location and access to transportation were often the pivotal factors in a patient’s choice,” notes Levine.
Well-intentioned health care providers also must deal with daunting barriers when trying to help patients transition to post-acute care, according to Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility. This report, based on discussions with administrators and frontline staff at eight hospitals and administrators from five nursing homes in the New York area, was written by Pooja Kothari, RN, MPH, UHF’s program manager and Joan Guzik, MBA, CPHQ, director of quality improvement for UHF’s Quality Institute.
Kothari and Guzik found that a hospital staff’s conscientious efforts are often hampered by a number of factors, specifically efficiency pressures, insurance constraints, authorization delays, and regulations that limit the assistance they can provide to patient and family caregivers. Other factors were identified, too —such as the need for specialized services or equipment, availability of social support, and other medical problems—can also limit post-acute care options.
Kothari noted that “Hospital staff members are often under immense pressure to minimize the length of hospital stays while managing a complex process involving the need to align multiple stakeholders around the discharge plan.”
Staff’s Efforts Hampered
“The unfortunate reality is that the best solution may not be possible when high-quality, post-acute care facilities have few available beds,” adds Kothari.
The first in UHF’s series, Difficult Decisions About Post-Acute Care and Why They Matter, provided an overview of post-acute care and examined the many factors that can hinder informed decision-making and limit care choices. The final report will spotlight promising best practices, innovations, and policy levers that could help support New Yorkers who need to make decisions about post-acute care.
“Access to meaningful information and decision support is missing, but it’s absolutely essential for achieving optimal outcomes,” said Lynn Rogut, director of quality measurement and care transformation for UHF’s Quality Institute, and head of the Difficult Decisions project.
All three reports can be downloaded from UHF’s website. Go to www.uhfnyc.org.