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Transitions from SNF to Home Lead to High 30-Day Hospital Readmission Rates

The rates of hospital readmissions after transitioning from hospital to a long-term care facility have been under scrutiny for some time because of the high costs to Medicare and Medicaid. Now, 30-day readmission rates after transitions to home from LTCs are being looked at too.

The results aren’t good. A study of 50,000 Medicare beneficiaries, aged 65 and older, showed that 22.1% went to the hospital to receive medical attention within 30 days of being discharged to home from a post-acute care facility. The number rose to 37.5% within 90 days of transitioning home.

No determination was made regarding how many of the hospital visits were potentially avoidable.  Digital Patient Care Tools

“Many participants used acute care services more than once in the 30 or 90 days after discharge from a SNF,” according to a study report in American Geriatrics Society.

A previous study of complicated transitions revealed that the 30-day readmission rates for patients being discharged from the hospital to home is 20% – two percentage points lower than discharges from an SNF to home.

The study revealed several risk factors that increased the likelihood a patient would seek treatment at a hospital within 30 to 90 days of returning home from an acute-care facility. They include being male, African-American or having been initially discharged from a for-profit facility or a facility that employs fewer licensed practical nurses per patient day. Cancer or respiratory disease also increased the risk, according to the findings.

Among risk factors the study authors see as being “amenable to intervention” are a lack of coordination of services and characteristics of specific facilities. They suggest a “multi-pronged approach for future studies and interventions” and “development of standardized transitional care services” as a possible solution.

General Medicine provides post-hospitalists — clinicians who specialize in the care of patients in long-term care facilities — to a variety of post-acute care settings. Because they hold regular, on-site office hours rather than responding to calls and making bi-weekly visits, one of the many benefits is transitions to home are better planned and patients and families are better prepared for them.

To find out how a Post-Hospitalist can help your facility improve transitions, limit 30-day readmission rates and cut overall healthcare spending contact General Medicine.

Tom Prose