Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize

Abstract

Post-acute care, encompassing long-term care hospitals, home health, inpatient rehabilitation, and skilled nursing facilities, is increasingly employed as an integral part of management for more complicated patients, particularly as hospitals seek to maintain costs and decrease length of stay. Skilled nursing facilities (SNFs) in particular are progressively utilized for patients with complex medical processes, including today's growing population of older hospitalized heart failure (HF) patients who pose a prominent challenge due to their high risks of mortality, 30-day readmissions, and substantial aggregate cost burden to the healthcare system. Publications to date have largely grouped post-hospitalized HF patients together when reporting demographic or outcome data, without differentiating those at SNFs from those at traditional nursing homes or other post-acute care settings. SNF patients suffer distinctive vulnerabilities and needs, and understanding these distinctions has implications for determining goals of care. In this review we evaluate HF patients referred to SNFs, and discuss the characteristics, outcomes, and management challenges associated with this particular population.

Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay

“…5,39 Patients with HFrEF admitted to SNFs often suffer declines in physical and cognitive function, have multiple comorbid conditions, and use many cardiac and non-cardiac medications. Despite this, use of standard pharmacotherapy among patients with HFrEF after a SNF stay is higher than reported previously.…”

Trends in inpatient discharges with drug or alcohol admission diagnoses to a skilled nursing facility among older adults, New York City 2008–2014

“…A broad effort should be made to increase the number of medical providers working in SNFs with a buprenorphine Drug Addiction Treatment Act (DATA) X waiver either from targeted training or discontinuing the buprenorphine X waiver to reduce the barriers to prescribing [ 20 ]. We also recognize the multiple challenges that exist in providing quality care in SNF settings for complex medical patients before even considering SUDs [ 21 ] and, therefore, models of care need to be developed to help assist providers in SNFs with the management of patients with SUD.…”

Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study

“…Though organizations have recently started publishing expert opinion based guidelines 17 for the SNF to home transition, there is no evidence that formal discharge practices occur routinely. HF patients discharged from hospital to SNF are more medically and functionally complicated than the overall Medicare HF population, 18,19 the latter who have a readmission rate of 21.7%. 20 Therefore, patients discharged from SNF may benefit from discharge planning since during a SNF stay medications may be started or adjusted, diets may be monitored and lab tests may be obtained, which may need post-SNF discharge follow up.…”