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Post-Acute Care: Resolving the Crisis Part I

When an older adult has been hospitalized and follow-up care is needed after discharge, families are often bewildered by how to locate, access, and pay for this care. Compared to younger adults, older adults require additional time to recover from a fall, acute illness, or complications of a chronic illness.  The process of finding services which will keep the older adult safe, provide continued treatment, promote a maximum level of functioning, are affordable, and are available is a daunting task for those who are not familiar with how the health care system operates.  Yet these decisions are important because they may have long-lasting implications for an older adult’s functioning and lifestyle.

A primary complicating factor of post-acute care is that decisions often need to be made quickly due to the recent trend for shorter hospital stays.  While a shorter stay reduces the risk of developing a hospital acquired infection, it also means that individuals are being discharged with more complex medical needs. In addition, the patient’s condition can improve, worsen, or vacillate back and forth throughout the hospitalization.  A discharge plan that appears appropriate one day may not be the best choice on the following day.   

When planning for discharge, consideration should be given to personal circumstances.  An older adult’s environment and support system are critical for the recovery process.  Does the older adult live alone? What was the older adult’s baseline level of functioning prior to hospitalization?  What additional health conditions exist which may impact recovery?  Who is available to help meet current needs?  How often will assistance be required?  Do caregivers have the skills which are necessary to provide appropriate care? Is the home environment suitable for a temporary or permanent change in mobility?

While home is often the most desirable destination following discharge and caregivers may have the best of intentions, individuals and families may find themselves unprepared to handle the many details which accompany an older adult’s recuperation from an illness or injury.  New medication regimens may be challenging to understand and follow, medical treatments may be needed such as wound care or oxygen therapy, and questions may exist regarding a “normal” recovery versus symptoms which indicate complications.  Add to these medical components any changes to the individual’s usual activities of daily living, and caregiving stress can accumulate quickly.

Families often look to hospital social workers, discharge planners, or case managers for assistance with arranging post-acute care services. These professionals are able to help families understand the providers and services which are available locally and will be covered by the patient’s insurance, which are two of the primary factors which drive post-acute care decisions.  These professionals usually advocate for patient choice regarding discharge decisions; but federal regulations, hospital policies, and limited experience with individual provider services (beyond speaking with the provider liaisons who visit the hospitals) may restrict their ability to provide specific recommendations based on the quality of services of care organizations and facilities.   

To fill this gap in knowledge about provider quality, families may request recommendations from family and friends who have experience with specific providers, or turn to the internet.  Reviews on Facebook, Yelp, Google, and other sites may be helpful but will not provide the full context of each writer’s experience.  The Centers for Medicare and Medicaid Services (CMS) has tools available for comparing care facilities and home health providers (  and, yet these tools also have limitations such as understanding the meaning and implications of reported data. Families who seek guidance from companies which offer “free” and “personalized” referrals for care services should be aware that each company’s recommendations may be limited to the service providers with whom they have financial contracts. Next week’s article will provide a general summary of the types of post-acute care which are available.

Karen Kaslow, RN, BSN