Post-Discharge Rehab Destination is an Important Decision

Patients now-a-days typically do not stay in the hospital until they are completely well or totally healed, but are discharged to skilled nursing facilities for continuing or closure of care.

Patients now-a-days typically do not stay in the hospital until they are completely well or totally healed, but are discharged to skilled nursing facilities for continuing or closure of care. A significant number of older patients -- about one in five -- opt for such facilities.

Deciding on the right post-discharge rehabilitation destination is important to future health and quality of life. However, it is a decision for which many patients and families are unprepared and unsupported, according to scientists from the Indiana University Center for Aging Research.

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Choosing a facility that matches the level of the patient's care needs is difficult. How often does a physician see residents at a particular rehab facility? Can laboratory tests be done urgently, if needed? Patients often have multiple medical problems; is specialized care and equipment provided for such patients?

"More Than Just Location: Helping Patients and Families Select an Appropriate Skilled Nursing Facility," published online ahead of print in the Annals of Long-Term Care, lays out a roadmap to assist hospitals in providing the support that patients and families need to select a facility that offers what the patient requires to return to health.

"I am a primary-care physician," said the paper's first author, Arif Nazir, M.D., an IU Center for Aging Research scientist and associate clinical professor of medicine at IU School of Medicine. "If I recommend knee surgery to a patient, I provide recommendations on physicians who I know do the procedure well. I don't say, 'You need surgery, so you should go out and find a doctor who operates on knees close to your or your daughter's home.' But that's really what often happens when patients are about to be discharged from hospitals and need to go to a rehab facility for continued care."

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"Typically hospitals provide a list of institutions and, because of misinterpretation of government regulations and lack of information on various facilities, don't give advice. Not knowing what to do and often needing to make a quick decision, the choice is frequently made by the patient and family based on location or physical attractiveness of the facility. But for short-term post-hospital admissions, the facility needs to be selected on how well they can continue the care the patient received in the hospital."

According to Dr. Nazir, hospitals may over-interpret Social Security Act regulations, enforced by Centers for Medicaid Services. These regulations state that the selection of post-discharge destination is a free choice. This does not, he says, absolve hospitals of the responsibility of providing unbiased assistance in the selection of the most appropriate facility.

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