Many hospitals are struggling with significant numbers of patients who have completed their acute hospital stay, but for whom post-hospital placement cannot be found. This ties up acute care beds in hospitals that are already running at or near capacity. Based on member concerns, a new goal has been added to the WSHA strategic plan: Explore policy options and process changes to speed up discharge for patients awaiting placement in long term care. WSHA is currently examining the array of issues related to discharge planning and we will continue to refine our understanding in this area.
WSHA is actively discussing the problem of post-acute discharge with the Health Care Authority, Department of Health, and Department of Health and Human Services. We are also exploring possible legislative and regulatory options.
WHSA has compiled the following list of opportunities for improvement:
- Evaluate the administrative day rate and whether it creates disincentives to discharge patients to skilled nursing facilities.
- Evaluate MCO network adequacy relating to skilled nursing facilities.
- Improve the process and timeline for patient evaluation and rate setting.
- Increase capacity for patients with complex needs, including dementia.
- Improve access to home health services.
- Explore improvements for securing surrogate decision makers.
WSHA recently surveyed members to gather qualitative and quantitative information about post-acute care discharge. Ninety percent of the 60 responding hospitals indicated they experience difficulty placing patients in need of post-acute services. Most respondents indicated that the most difficult patients are those with the following conditions: psychiatric/geropsych needs, combative, substance use history, obesity, dementia/confusion. The main barriers to placement in post-acute settings are the low daily payment rates, staff who are not comfortable caring for a patient’s needs, and the timing and accuracy of DSHS assessments. Responding hospitals had an average of 10-20 patients awaiting discharge and most wait 1 to 6 months.
Hospitals dealing with these issues are invited to contact Zosia Stanley with suggestions or information at zosias@wsha.org or (206) 216-2511.
