Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives

Abstract

Background/Objectives This research seeks to describe patients' experiences during the hospital discharge planning and skilled nursing facility (SNF) selection process. Design Semi-structured interviews, focusing on discharge planning and nursing facility selection, including how facilities were chosen, who was involved, and what factors were important in decision-making. Setting 14 SNFs in five cities across the United States. Participants 98 newly-admitted, previously community-dwelling SNF patients and/or their family members. Measurement Semi-structured interviews were qualitatively coded to identify underlying themes. Results Most respondents reported receiving only a list of SNF names and addresses from discharge planners and that hospital staff were minimally involved. Patients' choice of SNF was most often influenced by proximity to home and prior experience with the facility. Most respondents reported being satisfied with their placement, although many stated that they would have been willing to travel further to another SNF were it recommended. Many reported feeling rushed and unprepared, stating that they did not know where or how to get help. Conclusion SNF placement is a stressful transition, occurring when patients are physically vulnerable and with limited guidance from discharge planners. Therefore, most patients select a facility based on its location, perhaps because they are provided with no other information. Given CMS's proposed changes to the discharge planning process, this research highlights the value of providing patients and family caregivers with both quality data and assistance in interpreting it.

Geriatrics Literature 2017 Year in Review

“…Gadbois EA, Tyler DA and Mor V. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. J Am Geriatr Soc 2017;65:2459–2465 …”

The Conundrum of Choosing Post‐Acute Care: A Challenge for Patients, Families, and Clinicians

“…In this issue of the Journal of the American Geriatrics Society , Ayele and colleagues explore how perceived costs of care can play a critical role in the decision‐making process . This article builds on recently published articles in the Journal that explored factors contributing to decisions about skilled nursing facility (SNF) care and how patients and clinicians make decisions about PAC and long‐term care . The authors of the current study conducted structured interviews with clinicians, patients, and caregivers from three hospitals and three SNFs, asking three questions: (1) When do cost and insurance‐related discussions come up in the decision‐making process?…”

“…While cost will certainly drive much of the decision making, many other factors play a vital role in making person‐centered choices of PAC settings and locations (Figure ). Most of these factors have been discussed previously in the Journal . Patients may have had a prior positive or negative experience with a particular SNF or home health agency, or recognize in retrospect that they should have gone to a different level of care.…”

“…Although currently these clinicians are not supposed to make recommendations for specific PAC sites or providers based on Medicare policy, they are able to give their opinion on what setting and location might be best for an individual patient. Moreover, the Centers for Medicare and Medicaid Services (CMS) is considering new rules that would require hospitals to help patients select PAC providers by using quality measures …”

Preferred Post‐Acute Care Providers in Bundled Payment: Implications for Patient Choice

“…Finally, patients may derive other benefits from having broad freedom of choice. A key factor in a patient's choice of SNF is the distance from their home (although this may be due in part to a lack of information on SNF quality) . Other research found that hospitals discharged patients with different conditions to different post‐acute care providers .…”