Short-term nursing home residents experience gaps in care during transitions home, survey finds

Eighty percent of short-term nursing home residents said although they received and understood discharge instructions, they experienced gaps in preparation and care coordination, according to an October 2021 survey conducted by the United Hospital Fund. 

Researchers surveyed 263 residents and 249 caregivers across eight New York nursing homes, rehabilitation centers and other facilities. 

Researchers noted limitations to the study included the impact of the pandemic on the volume of discharged patients, limitation of survey sample size by decreased volume of short-stay discharges and lack of pairing in patient and caregiver responses.

Key findings: 

  • Ninety percent of residents felt ready to return home but only 66 percent of caregivers reported felt prepared to care for patients.

  • Seventy-seven percent of residents and 59 percent of caregivers reported experiencing problems when they returned home.

  • More than 40 percent of patients and caregivers reported that they did not receive a follow-up call from the skilled nursing facility after they were discharged.

  • Only 30 percent of residents and 28 percent of caregivers were informed by facility staff about medication side effects. Similarly, only 32 percent of patients and 29 percent of caregivers were told how to handle medication side effects.

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