The Conundrum of Choosing Post‐Acute Care: A Challenge for Patients, Families, and Clinicians

Abstract

This editorial comments on the Clinical Investigation by https://doi.org/10.1111/jgs.15768. in this issue.

Learning about sites of care for older adults: a jigsaw educational session for medical students

“…These training gaps lead to misconceptions about the post-discharge process and inadequate transitional care plans, resulting in inefficiency, miscommunication, medical errors and high-risk complications, including rehospitalizations and adverse drug events [ 5 , 6 ]. We propose a redesigned curriculum that prepares new clinicians to properly determine the best level of care for every patient and to educate patients and families on their options [ 7 ].…”

Effect of Enhanced Medical Rehabilitation on Functional Recovery in Older Adults Receiving Skilled Nursing Care After Acute Rehabilitation

“…1,2 In 2016, Medicare paid approximately $60 billion for postacute care, including 2.4 million SNF stays. 3 For such patients, postacute rehabilitation is a window of opportunity to regain functional ability. The alternative is persistent disability, which comes with considerable human costs, as well as high health care costs, 4 much of it resulting from rehospitalizations.…”

“…The use of postacute care has grown as frail and medically complex older adults survive medical events but with such functional incapacity that they are unable to return home and function independently . In 2016, Medicare paid approximately $60 billion for postacute care, including 2.4 million SNF stays . For such patients, postacute rehabilitation is a window of opportunity to regain functional ability.…”

Rehabbed to Death Reframed: In Response to “Rehabbed to Death: Breaking the Cycle”

“…The decision about where to receive post-acute care is complex and involves weighing several person-centered factors. 4 Most older patients would prefer to go home directly from the hospital, but this is not feasible or safe for many due to the home environment, lack of family members or friends who can provide necessary support, and/or lack of adequate financial resources to pay for in-home care that is not covered by Medicare or supplemental insurance. The Medicare skilled home health benefit can assist patients in going home when additional support is available for assistance with basic and instrumental activities of daily living.…”

“…The authors suggest that rehab facilities should be renamed to “after‐hospital transition in care.” The decision about where to receive post–acute care is complex and involves weighing several person‐centered factors . Most older patients would prefer to go home directly from the hospital, but this is not feasible or safe for many due to the home environment, lack of family members or friends who can provide necessary support, and/or lack of adequate financial resources to pay for in‐home care that is not covered by Medicare or supplemental insurance.…”