Choosing a Nursing Home for Mom

09 Jun 2020

With COVID-19 ravaging nursing homes, choosing quality care for yourself or a loved one after a hospital stay is more confusing and has higher stakes than ever. Forty percent of patients released from the hospital require follow-up care, or post-acute care (PAC), to continue the recovery process. Whether you need service from a home health agency, whose nurses visit you at home, or a skilled nursing facility, where you stay as an in-patient, the care you receive can either assist you on your journey back to health or land you back in the hospital. Pre-COVID-19, one in four patients transitioned to a skilled nursing facility were readmitted to the hospital within thirty days. Now that the pandemic is devastating PAC communities, it’s ever more critical for patients to choose wisely.

Unfortunately, Medicare data show that patients only choose the best-quality provider 14% of the time. Why? Because the standard protocol at hospitals is to offer a limited selection of options with little or no data to help patients make an informed choice. Typically, hospitals assemble a list of local providers and ask patients to choose three to five. With few details about the listed providers, patients usually choose the options closest to home. Hospital case managers contact only those options. The first provider to respond usually wins the patient’s business.

To ensure better health outcomes, patients and their families must expect transparency from hospitals. Specifically:

1. Hospitals should present you with a complete list of all available providers, not just preferred ones.

Typically, provider lists highlight PAC providers with which the hospital is affiliated, regardless of quality-of-care ratings. Rather than influencing patient choices in this way, hospitals should encourage patients to assess providers on their clinical merits.

2. Hospitals should offer to contact all providers with your case details and then present you with options that are ready to provide care.

The current search process, contacting three to five providers at a time, practically eliminates the likelihood that the highest-quality available provider will ever even be contacted. Moreover, this approach is cumbersome and time-consuming. Complex considerations like insurance coverage, clinical needs, and availability often mean repeating the process after the initial search comes up empty, thereby delaying discharges by up to half a day on average.

3. Hospitals should provide data on each provider to empower you and your family to make the right decision.

You should see not only publicly available information but also data on how successfully each facility has previously cared for patients with cases similar to yours. Armed with information, patients choose the highest-rated provider 85% of the time. So, if your case worker doesn’t provide you with this information when you’re choosing a provider, ask for it. Key metrics to request are:

Quality-related data

o Medicare Star rating
o Patient satisfaction rate
o Infection rates
o Citations

Resource Use data

o Hospital readmission rate
o Nurse-to-patient ratio

This protocol would represent a significant departure for hospitals from the traditional way of connecting patients with PAC. Many institutions are resistant to change but hospitals that have adopted the prescribed protocol have improved patient satisfaction and outcomes, and streamlined their own operations. “We had a referral system that was no longer keeping up with the goals we had for our patients and our health system. [Our new system] is bringing a new level of transparency to our care transition process,” said former Director of Disease Management and Care Management at Lancaster General Health, Kimberly Bahata.

Hospitals and health systems have a real opportunity to help ease patients’ fears during these trying times. By rethinking their old systems, hospitals can empower patients to make good healthcare choices in a new system that rewards high-performing PAC providers and incentives others to improve, elevating the entire healthcare community.