A new study of post-acute care transitions based on 2013 data has found that only a fourth of Medicare fee-for-service beneficiaries at the time were transferred from hospitals to skilled nursing facilities, and 56% were not transitioned to any post-acute care. 

Despite the challenges of providing and accessing skilled nursing and home healthcare in rural communities, post-acute care trajectories for rural Medicare beneficiaries have not been well-documented, wrote lead author Davis G. Patterson, Ph.D., from the University of Washington School of Medicine’s Rural Health Research Center.

He and his colleagues looked at the number and type of transitions to post-acute care within the study year, and they compared planned versus actual discharges to SNFs and home health agencies. For beneficiaries receiving post-acute care, they found that the most common trajectories were transition to SNF only, home health agency only, or SNF followed by home health care. The more isolated the community, the more likely beneficiaries were to receive care in a SNF and the less likely they were to receive care from a home health agency.

In addition, rural beneficiaries received fewer post-acute care services than were recommended by the discharging acute care hospital, depending on care type. Almost 90% of these patients with a planned discharge to a SNF received the planned care, whereas fewer than 60% of beneficiaries with a discharge to home health agency received home health services.

Compared with prior findings that combined rural and urban care data, an analysis of the current study’s results suggest that rural beneficiaries are less likely than urban beneficiaries to receive care from either a nursing home or home health agency following acute hospitalization, the authors concluded.

The findings also are in line with a study of all hospital discharges (all payers), which found that rural patients were less likely to receive post-acute care. This reality was driven by decreased discharges to a home health agency, the researchers noted.