UHF Highlights Methods to Improve SNF-to-Home Transitions

Transitions of care involving seniors especially those with multiple chronic conditions can be risky. Despite this, there are a number of methods skilled nursing facilities (SNFs) and other health care organizations can adopt to improve the transition from in-patient care to home for patients and their caregivers. That’s according to a report released Monday by the United Hospital Fund (UHF), a New York-based health equity nonprofit. The report is the result of UHF’s SNF Learning Collaborative, a two-year partnership with eight New York-based SNFs. The aim of the partnership was to enhance care transitions. One takeaway for home health providers is the importance of working with SNFs to further strengthen SNF-to-home transitions.

“Inadequate preparation for transitions frequently places frail and otherwise vulnerable older adults at risk of overuse of acute care services, declining health, permanent SNF residency, and high levels of stress, anxiety and dissatisfaction,” the authors wrote in the report. “For Medicare beneficiaries with multiple chronic conditions, lower socioeconomic status, dual Medicare/Medicaid eligibility, cognitive impairment or limited English proficiency, the risk of poor outcomes is even higher.”

In order to ensure success, SNFs need to play a key role in facilitating care transitions, the authors explain.