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From The LGH Physician Advisor Team
Setting expectations from the start assists with patient satisfaction! The expectation referred to here is discharge disposition. Patients who come from home are expecting to go home after their stay at the hospital.
It’s come to light that Lancaster General Hospital has a higher than average number of discharges to a skilled nursing facility. While this is not a critical concern, it could lead to the question, “Why do more of our discharges go to a nursing home for a ‘skilled nursing facility (SNF) bridge to home’ when compared to like counterparts?”
It has been demonstrated many times over that patients who go to SNF will not objectively regain their independence because they are not consistently challenged by what living at their home entails. Studies show that if patients with a goal of returning home are permitted to rehab in their own home, they are more likely to reach the functional status they possessed before hospitalization.
These words are simply to help the provider set the expectation, most beneficially from the start, giving the patient and family an idea of what the patient’s plan of care will be and the anticipated discharge disposition. Often families who accompany their loved one on their hospital journey will respond to the provider’s insight that the patient will need a brief time of increased help/supervision at discharge. It’s not in the patient’s best interest to tell them from the Emergency Department that they are going to a nursing home after their hospitalization.  Knowing they aren’t going home brings with it a feeling of defeat, and we as providers should always give our patients the best possible shot at the best outcome.
Admittedly, there are instances where the physical therapy (PT) notes give a recommendation of SNF post discharge. It would be best for providers to view this recommendation as one piece of the whole case to consider. It’s often taken that the PT note is the absolute key in determining the level of care needed at DC, but how many times has the patient simply not had a good opportunity to give their best?
Our patients expect their care team to consider the PT recommendation as well as the patient condition, goals to return home and the social support system in place before our team charges ahead with a discharge plan to skilled care.
Yes, it’s understood that “home with home health” is not going to meet every patient’s discharge needs. However, for those who really should be returning home with the goal of returning to their previous state of health and function, the hope is that the patient’s family, friends and support network will help with meals, cleaning and follow-up appointments. The real rehab at home is that the patient performs other daily functions, such as bathing, stairs and more walking in familiar surroundings, to meet their own needs.
So please consider these recommendations on how to improve patient satisfaction where discharge disposition is concerned! Notably, any questions and concerns can be addressed early on if the provider is engaged with the patient’s goals from the start. And when the goal is to return home, please take this seriously, as overall, it’s the patient’s best shot at returning to the previous level of functioning.

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