Every year, nearly 2 million people on Medicare — most of them older adults — go to a skilled nursing facility to recover after a hospitalization. But choosing the facility can be daunting.
Typically, a nurse or a social worker hands out a list of facilities a day or two — sometimes hours — before a patient is due to leave. Families scramble to make calls and, if they can find the time, visit a few places. If asked for a recommendation, hospital staffers typically refuse, citing government regulations.
“The reality is that we leave patients and families without good guidance at a really vulnerable point in their care trajectory,” said Dr. Robert Burke, an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.
What do older adults and family members need to know before selecting a rehab facility after a hospital stay?
• The basics: Who needs post-hospital care in a rehabilitation center? Surprisingly, there are no definitive guidelines for physicians or discharge planners. But older adults who have difficulty walking or taking care of themselves, have complex medical conditions and complicated medication regimens, need close monitoring or don’t have caregiver support are often considered candidates.
Medicare will pay for short-term rehabilitation under two conditions: (1) if an older adult has had an inpatient hospital stay of at least three days; and (2) if an older adult needs physical, occupational or speech/language therapy at least five days a week or skilled nursing care seven days a week. Be sure to check your status.
• Quality varies widely: According a 2018 report from the Medicare Payment Advisory Commission, facilities with the worst performance were twice as likely to readmit patients to the hospital as those with the best performance. Patients at the best-performing facilities were much more likely to be discharged back home and to regain the ability to move around than those at the worst-performing facilities.
Later this month, for the first time, Medicare’s Nursing Home Compare website is separating out performance measures for short-term stays for recovery after a hospitalization. There will also be a separate “star rating” for short-term stays — an overall indicator of quality.
• Questions to ask at the hospital: What kind of help will I need, and for approximately how long? What is my anticipated recovery, and what do you think the most difficult parts of it might be? Why is a skilled nursing facility being recommended instead of home health care?
• Questions to ask at facilities: Is a doctor readily available? What kind of equipment and specialized services are on-site?
• Take enough time: Burke suggests that older adults or their families insist they be given time to contact facilities if they feel rushed. While there’s considerable pressure to discharge patients quickly, there’s also a requirement that hospital discharges be safe, he noted.
“If we’re waiting for a family to tell us which facility they want a patient to go to, we can’t make a referral or discharge the patient,” he said.
— Judith Graham, Kaiser Health News