Show Summary Details

Page of

Printed from Oxford Research Encyclopedias, Global Public Health. Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice).

date: 11 February 2025

Improving Post-Acute Care Quality for Older Adults in the U.S.: Nursing Homes and Beyondlocked

Improving Post-Acute Care Quality for Older Adults in the U.S.: Nursing Homes and Beyondlocked

  • Caroline P. ThirukumaranCaroline P. ThirukumaranOrthopaedics, University of Rochester
  • , and Brian E. McGarryBrian E. McGarryGeriatrics/Aging, University of Rochester

Summary

Medical and surgical post-acute care (PAC) encompasses the rehabilitative and palliative health services that individuals typically receive following a stay in an acute care hospital and is a critical source of post-hospitalization care for Medicare-insured patients undergoing surgeries such as hip and knee replacements, or with medical conditions such as septicemia or severe sepsis. PAC, commonly delivered through skilled nursing facilities (SNFs), has long been prone to quality issues, and national policies are routinely reformed to improve their quality. Yet reform initiatives are often hampered by challenges related to the measurement of quality and the way in which PAC, especially in SNFs, is financed. Moreover, the lack of clear guidelines about the optimal PAC setting (e.g., institution vs. home) and the clinical and social characteristics of patients that may benefit from a particular setting has resulted in PAC being a source of wasteful spending. These challenges have been heightened by extensive payment reforms following the passage of the Patient Protection and Affordable Care Act and the COVID-19 pandemic. These changes have the potential to upend the status quo of the PAC business model, with wide-ranging potential implications for older adults’ access to high-quality rehabilitative care. The determination of value in PAC settings has commonly used Medicare claims and assessment data; focused on metrics such as readmissions, length of stay, spending, and transition to the community; and relied on reporting through the Care Compare website. The advances in PAC-focused reforms and the growing emphasis on care coordination have motivated promising initiatives such as standardization of metrics across PAC settings; the use of accountable care organizations and episode-based bundled payments for PAC reimbursement; the use of telehealth; and other innovations that are positioned to encourage the delivery of high-quality rehabilitative care.

Subjects

  • Special Populations

You do not currently have access to this article

Login

Please login to access the full content.

Subscribe

Access to the full content requires a subscription