According to a federal panel facilitated by the Medicare Payment Advisory Commission (MedPAC), “almost half of skilled nursing facility residents had five or more higher-quality facilities available in their area that they were not directed to by a discharging hospital.” This is a concerning statistic for a multitude of reasons, considering the health, livelihood and ongoing care of a senior is at stake.
Why are some patients and their families not being directed to the top facilities in their area when discharged from the hospital? While the answer isn’t simple, the question has raised much-needed consideration in the health-care industry around the role of hospital discharge planners.
The Difficult Role of Hospital Discharge Planners
A New York Times article entitled “Bridging Gaps Between Hospital and Home” explores the vital role of hospital discharge planners in the health care system.
These “health care traffic cops” are responsible for “patrolling a wildly busy intersection of medical, economic and social challenges,” and ensuring that a person has “safe and adequate” living accommodations and support when they are discharged from hospital, the article explains.
Ultimately, discharge planners are exposed to all kinds of circumstances and distressing situations, including patients who are “elderly, impoverished or just reeling from a diagnosis.” Some things they ask patients upon discharge include:
- Do you require a ride home?
- Do you have a home?
- Patients without permanent addresses need a safe place to live before their discharge can be authorized.
- Do you need help with activities of daily living?
- i.e., bathing, getting dressed or preparing meals?
- Do you need assistive devices?
- i.e., grab bars in the shower
- Do you have someone who can support you and take you to follow up appointments?
- Do you require further aftercare?
- i.e., Skilled nursing care or physical therapy
Discharge planners must work magic in their roles, negotiating with insurance companies and long-term care facilities to set up appropriate support for a patient, often with limited resources. Unfortunately, it’s not surprising that discharge planners – usually social workers by trade – have a high rate of burnout in their profession.
The Missing Link
A report published by McKnight’s Long-Term Care News suggests that almost half (46.8%) of nursing home residents were discharged from the hospital to facilities that scored lower in quality than five or more other providers in the area.
The report found that many patients are not given a choice (and are not even informed that there was more than one option to choose from) in determining which facility they would be discharged to. This report makes the situation clear: there is a critical missing link when educating patients and offering them a choice in their ongoing care.
Another major issue is that discharge planners are not always empowered to work in the best interest of the patient. According to the report, “discharge planners currently are limited by rules as to how they can educate or steer patients on their post-acute options.” These regulations cause a snowball effect and lead to other major issues, including:
- Planners being overburdened by a crushing workload and lack of resources;
- Planners directing people to facilities based on their own personal preference or interest;
- Planners having little knowledge about Skilled Nursing Facilities and how they operate;
- Patients, who were poorly prepared for discharge, winding right back in the hospital.
The Proposed Solution
After outlining the major problems being faced by patients and hospital discharge planners alike, MedPAC recently recommended modifying discharge planning rules to:
“Allow hospitals to recommend the specific nursing home and home health providers,” a practice that’s already being implemented in other facets of the healthcare system, including the Comprehensive Care for a Joint Replacement program.
This change would allow discharge planners to consider the comprehensive data of a facility or home health agency, including quality ratings, and share this unbiased information with a patient when developing their discharge plan.
What Does This Mean for Patient Care?
The changes that MedPAC suggests would be a positive shift towards patient-centered care, allowing patients to actively participate in their discharge planning and feel confident that they are moving on to the highest quality post-acute facility in their area.
This change could also decrease the rate of costly and burdensome patient readmissions by ensuring individuals are being placed in the best possible facility or being set up with the best possible home health resources the first time around. This is a win-win situation for patients, hospitals and Medicare alike.
What do you think about MedPAC’s proposal? Please share your thoughts with us in the comments below.