Healthcare News & Insights

Keys to better discharge planning if patients need skilled nursing care

Discharge planning is often challenging for patients and providers alike, especially if a patient may need to stay at a skilled nursing facility after leaving the hospital. To ensure the best outcomes for patients, it’s important for hospitals to take a more active role with helping patients and their families navigate the discharge process. 

A report from the United Hospital Fund, a New York nonprofit dedicated to finding ways to improve patient care, highlights some of the barriers hospitals face with helping patients understand their options after discharge when they’re going to a post-acute care facility and offers some suggestions for improvement.

Hurdles to clear

There are many challenges for hospitals when planning a patient’s discharge to a skilled nursing facility. For starters, these patients often have medically complex needs, so it’s necessary to coordinate consultations from a variety of providers and specialists. And since they have complicated medical issues, their medical status could change at any time, which could also change their discharge options.

The situation can become worse if patients are experiencing multiple chronic conditions, dementia or a behavioral health condition. In addition, it’s difficult to find a spot in a skilled nursing facility for patients with substance abuse issues or who need expensive equipment/medication to sustain their health.

Working with patients’ family members can also make discharge planning difficult. Sometimes, effective communication can be challenging, whether it’s due to a language barrier or because the patient’s family isn’t nearby. In other cases, family members may have a different idea of the patient’s health condition than providers do, which can make it tough for them to accept certain recommendations for post-discharge care.

In addition, pressure to discharge the patient as soon as possible has an impact on planning. Facilities report they’re strongly encouraged to optimize the length of stay so patients are ready for discharge earlier.

There’s also pressure to release the patient at just the right time, given the Medicare three-day rule saying that patients will only be covered for skilled nursing care if they’ve stayed in the hospital for at least three consecutive days.

Even once a patient’s ready for discharge, red tape from insurance companies can impact the process. It could take days for a payor to review a patient’s medical record to authorize a stay at a skilled nursing facility. Meanwhile, the patient’s stuck in limbo and not being discharged in a timely manner. By the time the process is finished, a bed may not be available in the facility of the patient’s choice, which may cause anger and frustration.

Improving discharge planning

To take some of the difficulty out of the discharge planning process in these situations, the report offers several suggestions for hospitals, including:

  • Give patients and their families more detailed info about what they can expect at a skilled nursing facility.
  • Train clinical staff on talking with patients and families during the discharge planning process, making it clear what support and info they should be offering, and what they shouldn’t do.
  • Make staff more familiar with quality data on the Centers for Medicare & Medicaid Services Nursing Home Compare website, and let them know what’s available through state databases, so they can make informed recommendations to patients and families.
  • Prioritize providing support for disadvantaged or vulnerable patients, including those with family caregivers who can’t visit facilities, low health literacy and limited computer skills.
  • Consider hiring interpreters or offering other info resources for patients who don’t speak English.
  • Work closely with payors to prevent authorization delays by finding out the info they want beforehand.
  • Keep up to date on best practices for decision making when it comes to discharging patients to skilled nursing facilities, and explore new support tools and resources.

Following these recommendations could streamline the discharge process at your hospital.

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