Placement decisions tricky for at-risk seniors

Often SNF 'safest discharge' to make

Discharge planning for the high-risk "frail senior" population is difficult at best, says Barbara Leach, RNC, MS, CNA, ACM, director of case management, Sacramento/Solo, with the Sutter Health Sacramento Sierra Region.

"Often the decision to send an elderly patient to a skilled nursing facility [SNF] for further recovery and evaluation is the safest discharge we can make."

Keeping people in acute hospitals for long lengths of stay is not good for many reasons, she notes. "For the elderly it is very disruptive and often leads to delirium, which puts them at risk."

Determining whether it is safe for the person to return home to be cared for by intermittent caregivers or an elderly mate is also a risky proposition, Leach adds.

"At Sutter Medical Center, we do see our elderly patients early in their stay," she says. "We collaborate with the patient, his or her family, and the care team for the best discharge plan we can."

Hospital Access Management asked Leach to comment on testimony given at a recent joint hearing of the Assembly on Aging and Long-term Care Committee and the Assembly Health Committee of the California legislature.

The hearing, which focused on the discharge plans that hospitals provide for patients, drew critical reactions from several patient advocacy groups and other organizations.

Some told the panel that as health care costs have risen, hospital stays have shortened, and patients are more and more likely to leave with inadequate after-care plans and end up back in the hospital.

Hospitals — and Medicaid regulations — were criticized for steering patients to costly institutional facilities, rather than arranging for more cost-effective home health services.