Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility

Health care providers face daunting barriers when trying to help patients negotiate the transition to post-acute care. This report describes those barriers and is based on discussions with administrators and frontline staff at eight hospitals in the New York metropolitan area, as well as administrators from five nursing homes. It is the third in UHF’s Difficult Decisions series, a year-long inquiry into why discharge planning can fall short despite well-intentioned efforts by hospital staff. 

The authors found that when implementing discharge planning, hospital staff face time pressures, insurance constraints, and authorization delays and that they must navigate federal and state regulatory restrictions as well as the culture and environment of their own institutions. All of this complicates the process for patients and their families. Patients' choices of skilled nursing facilities can be limited by their medical conditions, behavioral and psychiatric health histories, need for specialized services or equipment, insurance, and financial status. These factors can leave them with few options.

The Difficult Decisions series was supported by the New York State Health Foundation. Other reports in the series look at the many factors that make informed decision-making about post-acute care so challenging; the experiences of patients and family caregivers; and the best practices, innovations, and policy levers that could help support New Yorkers who need to make decisions about post-acute care.