Coordinating post-acute services for patients has been an ongoing challenge during the COVID-19 pandemic. One solution is for hospitals to form partnerships with local skilled nursing facilities. These partnerships can help hospitals find adequate care for complex patients. Hospital case managers and other staff can help the skilled nursing facility with difficult problem-solving and care coordination.
A program created to help children and young people, from birth to age 25 years, with chronic illnesses has evolved into a way to prevent emergency department visits and rehospitalizations for any population, including at-risk, older adults.