Public Release: 

Hospitalized older adults may need more help selecting skilled nursing facilities

American Geriatrics Society

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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This summary is from "Selecting a Skilled Nursing Facility for Post-Acute Care: The Patient and Family Perspective." It appears online ahead of print in the May 2017 issue of the Journal of the American Geriatrics Society. The study authors are Emily A. Gadbois, PhD; Denise A. Tyler, PhD; and Vincent Mor, PhD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

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