Two UHF Reports Highlight Challenges Faced by Patients and Providers in Transition to Post-Hospital Care

NEW YORK, NEW YORK January 9, 2019— Hospital patients face significant challenges when identifying the post-acute care option that can best meet their needs after major surgery or a serious illness, as outlined in two reports released today by United Hospital Fund (UHF). The reports are the next two installments in UHF’s four-part “Difficult Decisions” series, based on a year-long inquiry into post-hospital care. The effort is supported by the New York State Health Foundation (NYSHealth).

The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers is based on discussions with patients and family caregivers about their experience selecting a skilled nursing facility during hospital discharge planning. The report’s authors—Carol Levine, MA, director of UHF’s family caregiving initiatives and Kristina Ramos-Callan, MA, a UHF program manager—found that the patients and their families felt rushed and reported having little say when choosing a post-acute care facility.

“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 Ms. Levine. “In the end, location and access to transportation were often the pivotal factors in a patient’s choice.”

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. The 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 UHF program manager Pooja Kothari, RN, MPH, and Joan Guzik, MBA, CPHQ, director of quality improvement for UHF’s Quality Institute.

The authors found that a hospital staff’s conscientious efforts are often hampered by efficiency pressures, insurance constraints, authorization delays, and regulations that limit the assistance they can provide to patient and family caregivers. Other factors—such as the need for specialized services or equipment, availability of social support, and other medical problems—can also limit post-acute care options.

“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,” said Ms. Kothari. “The unfortunate reality is that the best solution may not be possible when high-quality, post-acute care facilities have few available beds.”

The first in the series, Difficult Decisions About Post-Acute Care and Why They Matter, provided an overview of post-acute care and 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.

Jan. 8, 2019
Focus Area
Clinical-Community PartnershipsQuality and EfficiencyCoverage and Access
Quality Institute