Discharging Elderly Patients From The Hospital: What Are Your Care Options As A Family Member Or Caregiver and How They Differ?

As people age and their capacity to live independently and safely changes, questions arise about whether or not living in a private home is a viable option. Once an older adult and/or their family determines that extra help is needed, they start to delve into alternative living options. As their research commences, pop-up words like “skilled nursing”, “assistive living”, and “transitional care unit” grace the computer screen. Unfortunately, there are many older adults and their family members/caregivers who have no idea what these words mean.

The following terms are commonly used to describe commonly known facilities for older adults in the United States and included are some basic descriptions:

Facility Options After Discharge from the Hospital:

Skilled Nursing Facility: A SNF or a SNRC (Skilled Nursing and Rehab Center) is staffed with nursing and medical doctors 24/7 and includes overnight stays, rehabilitation (therapy) services, assistance with hygiene, and daily meals. A SNF is ideal for a patient who is well enough to discharge from the hospital but cannot function independently or with help at home. The length of stay varies depending on each patient’s rehab needs, however Medicare will often cover up to 100 days if services are clinically justified.

Acute Care Rehabilitation Facility:  Acute care rehab is also an overnight, extended inpatient stay. This option is designed for patients who will strongly benefit from a multi-disciplinary approach (i.e. post-stroke, traumatic brain injury, spinal cord injury, etc.). Patients have to meet certain qualifications including the ability to tolerate up to 3 hours of therapy per day, 6 days per week (i.e. occupational, physical, and speech). There are also doctors, psychiatrists, nurses, respiratory therapists, and a wide array of other disciplines on staff. Often times, patient’s transition to acute care rehab after an acute care hospital stay or even after going to skilled nursing.

Transitional Care Unit:  TCUs are very similar to skilled nursing facilities, except that the expected length of stay is much shorter. Patients can expect to stay anywhere between 5 to 21 days. TCUs are helpful options for patients who are still not quite well enough to return home from the hospital.

Residential Care Facility: Also called assistive living, residential care homes are facilities are long-term living options for older adults. The resident is provided with lodging, daily meals, and nursing/rehabilitative staff as needed. In order for prospective residents to qualify, they need to be somewhat independent in all daily living tasks. Many assistive living homes have aides available for showers if needed.

Retirement Community: Continuing care retirement communities are long-term living situations for older adults that come with a wide variety of healthcare services. Residents can rent or purchase real estate within a community setting that is serviced with medical and rehabilitation options. Not all residents are required to participate in medical or rehab services, but the options are there and can be appropriately billed to each resident. The retirement community is ideal for an older adult who is still quite independent but could benefit from immediate healthcare assistance. However, retirement communities are very expensive and should be thoroughly researched.

Nursing Home: Nursing homes are long-term living facilities that often operate much like a hospital setting. Residents live in nursing homes because they do not need to be in a hospital, but they are unable to function independently and safely in a private home. Nursing homes are different from residential care because the facility is staffed 24/7 with nurses and doctors (quite similarly to a skilled nursing facility). Patients often have access to rehabilitation services if needed. A nursing home is often a last resort for older adults if private homes and assistive living are no longer safe options due to health and functional capacity (i.e. severe dementia, chronic degenerative diseases like multiple sclerosis, etc.).

While researching alternative living options for older adults, keep in mind what the goals are and what specific needs should be met. Some facilities may only be relevant if the older adult is discharging from the hospital such as skilled nursing or transitional care. For other situations in which the older adult can still get around independently but needs some assistance, assistive living and retirement communities may be more suitable. Assess each type of facility thoroughly before settling on the one that is right for you.

Discharge Plan of Care Summary:

Make sure to have a case manager at the hospital explain to you and your family members or caregivers what each facility is and why would a patient be discharged to either of those facilities based on a particular functional level.

Also, have them explain the expectations of a patient going into these facilities. ( i.e In acute rehab, most patients stay for 2-3 weeks with the disposition of returning home to independent living. Nursing home residents are usually dependent, stay long term due to inability to care for themselves or have no assistance available at home).

Knowing the options you have for your aging parent will help you make better decisions when the time comes to move on to the next level of care.