Complex health care decisions for skilled nursing facilities and their residents: A discussion of recent Centers for Medicare and Medicaid services updates to survey and certification interpretive guidelines for feeding tubes and advance directives

2013 ◽  
Vol 34 (6) ◽  
pp. 500-502
Author(s):  
Howard L. Sollins ◽  
Samantha C. Flanzer
Keyword(s):  
Health Care ◽  
Advance Directives ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Health Care Decisions ◽  
Skilled Nursing ◽  
Feeding Tubes

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities

2016 ◽  
Vol 19 (1) ◽  
pp. 45-70 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher S. Brunt ◽  
David C. Grabowski
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Medicare Reimbursement ◽  
Care Providers ◽  
Skilled Nursing ◽  
For Profit ◽  
Market Dominance ◽  
Selection Of

Abstract Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.

Abstract P306: The Association of Discharge Disposition With 30-Day Readmission After Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shumei Man ◽  
David Bruckman ◽  
Anne S Tang ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Home Health Care ◽  
Home Health ◽  
Medical Advice ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Short Term ◽  
Skilled Nursing ◽  
Discharge Disposition

Objective: Readmission after ischemic stroke presents immense social and financial burden on patients, families and society at large. Post-stroke follow-up, a way to prevent readmission, has generally been focused on patients discharged to home with limited attention to those discharged to other facilities. This study aimed to examine 30-day readmission likelihood among patients of different discharge disposition. Methods: We studied patients who were hospitalized for ischemic stroke in states of Wisconsin, Iowa, Arkansas, and New York in 2016-2017 using the Healthcare Cost and Utilization Project State Inpatient Database. Generalized estimating equation was used to study the association of discharge disposition with 30-day all-cause readmission, after adjusting for patient sociodemographics, 23 comorbidities, hospital characteristics, in-hospital complications, and proxies for stroke severity, accounting for in-hospital clustering. Results: Among 52,301 patients hospitalized for ischemic stroke, 45% were discharged to home without home-health-care, 19% to home with home-health-care, 33.5% to rehabilitation and skilled nursing facilities, 1.5% to short-term hospital, and 0.93% left against medical advice. Patients discharged to home accounted for 34.7% of total 30-day readmissions while discharged to rehabilitation and skilled nursing facilities accounted for 40.6% of total 30-day readmissions. Compared to the patients discharged to home without home-health-care which had the lowest 30-day all-cause readmission rate (8.4%), patients with other dispositions were at higher likelihood of readmission: home with home-health-care (11.3%, adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.28); rehabilitation and skilled nursing facilities (13.2%; adjusted OR, 1.33; 95% CI, 1.22-1.46); short-term hospitals (23.7%; adjusted OR, 3.09; 95% CI, 2.44-3.93); and left against medical advice (18.6%; adjusted OR, 2.2; 95% CI, 1.75-2.83). Conclusion: Patients who are discharged to rehabilitation and skilled nursing facilities after ischemic stroke are at high likelihood of 30-day readmission and should be a focus of discharge planning to prevent events that lead to readmission.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s151-s152
Author(s):  
Lauren Epstein ◽  
Alicia Shugart ◽  
David Ham ◽  
Snigdha Vallabhaneni ◽  
Richard Brooks ◽  
...  
Keyword(s):  
Public Health ◽  
Acinetobacter Baumannii ◽  
Median Number ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Single Facility

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.Funding: NoneDisclosures: None

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