Difficult Decisions About Post-Acute Care and Why They Matter

Each year, approximately 1 in 5 hospital patients in the United States, including some 300,000 New Yorkers, require continued care following hospital stays for major surgery or serious illness. Yet too often, patients and their families do not have the critical information and support they need to carefully assess their options and make the best possible decisions.

A new report by the United Hospital Fund (UHF), supported by NYHealth, spotlights the many factors that can hinder informed decision-making and limit care choices. UHF conducted a year-long inquiry to better understand why hospital discharge planning can fall short despite well-intentioned efforts by hospital staff. There are many factors that can hinder informed decision-making, including lack of awareness by patients and family caregivers that quality of care varies or reluctance by discharge planners to offer direct advice because of concerns about complying with federal regulations. Information on post-acute care that is available online can also be difficult for patients and their families to navigate.

The report combines UHF’s research with input from patients and their families, health care providers, researchers, policymakers, and other stakeholders to identify promising approaches for supporting decision-making at discharge. It is the first in a series of reports by UHF that takes a broad look at the many factors, including regulation, that make informed decision-making about post-acute care so challenging.

The second report in the series, “The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers,” relates the experiences of patients and their family caregivers being discharged from a hospital and spotlights the barriers to informed decision-making. Findings reveal that patients and their families felt rushed, uninvolved, and provided with insufficient information when choosing a post-acute care facility.

The third report in the series, “Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility,” provides insight on the challenges health care providers face when helping patients transition to post-acute care, highlighting discussions with administrators and frontline staff at eight hospitals in the New York State. The report finds that staff members’ efforts are frustrated by inefficiency pressures, insurance constraints, authorization delays, and regulations that limit the support they can provide to patients and family caregivers.