Approximately 20% of hospitalized patients are discharged to a skilled nursing facility for post hospitalization sub-acute care. The prevalence of frailty, unresolved acute health problems, a history of chronic illness, and various functional and psychological needs among these patients is high. The complexity of post-acute care needs has not matched the development of innovative and effective skilled nursing facility care models. Furthermore, no standardized systems of care have been implemented and care delivery at a given skilled nursing facility may vary significantly from that of others. Thus, it is no surprise that many skilled nursing facilities fail to go by evidence-based guidelines for medical management for various illnesses and health outcomes.
The Office of Inspector General recently reported that more than 30% of patients are vulnerable to harm within a few weeks of their admission to a skilled nursing facility. To enhance patient outcomes, it is important that health providers improve their “usual care” within long-term care facilities like skilled nursing facilities.
Interventions that are multi-component, person-centered, and interdisciplinary have shown to improve patient satisfaction and health outcomes within hospitals. Similar innovations in care delivery have not yet been tested within skilled nursing facility settings. The shift of the health care systems from volume-based to value-based reimbursements and greater attention on accountability of performance is putting pressure on skilled nursing facilities to give care that is more structures, higher in quality, and more inclusive of patients. A recent report from the Journal of the American Medical Directors Association described an innovative, individualized model of care (the Patient-Oriented Interdisciplinary Sub-Acute Care [POISe-Care] model) that is currently being implemented and evaluated within a skilled nursing facility in Indianapolis, IN. The model was designed by the facility medical director and aims to address the unique challenges to patient-centered, individualized care while giving prompt and complex care to skilled nursing facility residents.
The time for skilled nursing facility leaders to think innovatively and utilize adaptive leadership strategies to reconstruct staff beliefs, vision, and responsibilities to implement innovative care models is long overdue. Models like POISe-care that are unique approaches that embody high-quality geriatric team care and focus on addressing gaps in patient-centeredness and physician involvement should be encouraged.