Empty nursing home bed

Ensuring the best post-acute care outcomes for assisted living residents will require an improved understanding of the long-term care services landscape among hospital clinicians and discharge workers, the authors of a new study contend.

Investigators from the University of Rochester in New York used a national database to ​​examine links between post-acute care referrals of assisted living residents to skilled nursing facilities, home healthcare and home, and 30- and 60-day outcomes after hospital discharge. 

SNFs are the top post-acute care referral setting for U.S. assisted living residents (40%), mirroring that of the overall Medicare population, they found. This was followed by home without home healthcare (28%), home with home healthcare (17%) and other settings (15%).

Residents’ 30- and 60-day outcomes vary across these settings, depending on multiple characteristics of the individual, the assisted living community, the discharging hospital and the region, the authors found. 

Discharge to an SNF is associated with the fewest hospital and emergency department readmissions when compared with other destinations, for example. But an SNF placement also comes with higher odds of an extended long-term care stay and mortality when compared with discharge home with home healthcare. And referrals to home with and without home healthcare are associated with a range of desirable and adverse outcomes as well, the authors reported. 

The results highlight the complexity of these post-acute care transitions, which not only must consider assisted living residents’ needs but also available beds, wrote lead author Jinjiao Wang, Ph.D., RN. 

What’s more, hospital clinicians and discharge planners often are unfamiliar with the different services and target populations of assisted living communities and nursing homes, Wang and colleagues explained. In addition, recent reforms may affect post-acute care providers’ ability and willingness to offer certain care to patients, they wrote. 

With the assisted living industry being the fastest-growing residential care provider in the United States, better communication between acute care and post-acute care stakeholders would help ensure that residents land in the most appropriate settings, the authors said. And more work is needed to ensure that the most vulnerable, such as racial/ethnic minorities and people living with Alzheimer’s disease and related dementias, receive the right type of care, they added.

“At hospital discharge, clinicians and discharge planners should be provided information about the exact type and availability of services at assisted living to make the most appropriate discharge referrals for [those] residents,” they concluded.

The study was published in the Journal of the American Geriatrics Society.