Study explores how hospitalized older adults make decisions about choosing skilled nursing facilities

More than 20 percent of all hospitalized older adults who use Medicare will be admitted to a skilled nursing facility following a stay in the hospital (also known as "post-acute care"). However, these men and women may be given too little information when it comes to choosing a post-acute care facility: sometimes they may receive just a list of addresses for local facilities. What's more, hospitalized older adults typically don't plan for care at a skilled nursing facility ahead of time. This can lead to making important decisions too quickly or during a time of particular stress.

We don't have much information about how people select skilled nursing facilities or what information they're given to make informed choices. So a team of researchers recently studied how hospitalized older adults make decisions about choosing a facility, who helps them decide, what they think about the process, and what they consider as they make decisions. The researchers published their study in the Journal of the American Geriatrics Society.

They interviewed 98 older adults who had just been admitted to a skilled nursing facility. In 90 interviews in five cities across the country, the researchers spoke only to the older adult. A family member participated in the other eight interviews.

Of the people interviewed:

  • Seventy-eight had been admitted to the hospital due to an emergency--usually a fall (30 people), cancer (eight people), or an infection (seven people).
  • Nineteen people had planned hospitalizations, mostly for joint replacements. Only nine of them had chosen a skilled nursing facility before their surgeries.
  • Most people said they had to choose a skilled nursing facility the day before or even the day of being discharged from the hospital.
  • Sixty-six study participants chose a skilled nursing facility on their own; 19 people had a family member or friend make the decision. The hospital staff chose the facility for 12 individuals.
  • Thirty-five patients had previously stayed in the skilled nursing facility they'd chosen; 54 people had never stayed in a skilled nursing facility before.

Additionally, most study participants reported having a negative experience choosing a nursing facility. For example, some respondents said:

  • They had very little time to choose a skilled nursing facility.
  • Hospital discharge planners simply gave them lists of facility names and addresses.
  • Healthcare professionals involved in their care gave older adults little guidance about choices.

Important factors in choosing a skilled nursing facility included whether the older adult or family/friends had been to the facility and whether the facility was close to home. Only a few people reported choosing facilities based on more/better staff, cleanliness, or amenities.

The researchers concluded that the decision to choose a skilled nursing facility after hospital discharge is often rushed. They also said that older adults are rarely given enough information to make an informed choice. Improving communication and making more information and resources available to candidates for skilled nursing facility care could help improve not only well-being but also our experiences with the healthcare system.

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