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Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay
Author(s) -
Tyler Denise A.,
McHugh John P.,
Shield Renée R.,
Winblad Ulrika,
Gadbois Emily A.,
Mor Vincent
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12987
Subject(s) - skilled nursing facility , unintended consequences , medicine , minimum data set , authorization , data collection , data extraction , medline , nursing , emergency medicine , nursing homes , computer science , law , statistics , computer security , mathematics , political science
Objective To identify the challenges that reductions in length of stay ( LOS ) pose for skilled nursing facilities ( SNF s) and their postacute care ( PAC ) patients. Data Sources/Setting Seventy interviews with staff in 25 SNF s in eight U.S. cities, LOS data for patients in those SNF s. Study Design Data were qualitatively analyzed, and key themes were identified. Interview data from SNF s with and without reductions in median risk‐adjusted LOS were compared and contrasted. Data Collection/Extraction Methods We conducted 70 semistructured interviews. LOS data were derived from minimum dataset ( MDS ) admission records available for all patients in all U.S. SNF s from 2012 to 2014. Principal Findings Challenges reported regardless of reductions in LOS included frequent and more complicated re‐authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNF s being pressured to discharge patients within certain time limits. Some SNF s reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. Conclusions The push for shorter LOS has resulted in unexpected challenges and costs for SNF s and possible unintended consequences for PAC patients.