Empowering Health Care Consumers


United Hospital Fund

Funding Area

Empowering Health Care Consumers


March 2019


Following a hospitalization for an illness or injury, one in five patients need additional health care services for their recovery, typically in a nursing home or rehabilitation facility, through outpatient therapy, or at home.

For patients and their families, however, choosing where to seek post-hospital care after being discharged can be among the hardest decisions they have to make. Although there may be resources available, many patients aren’t aware of their options or feel rushed in their decision-making.

A new report by the United Hospital Fund (UHF), supported by NYHealth, is the final installment in UHF’s four-part “Difficult Decisions” series, based on a yearlong inquiry to better understand why hospital discharge planning can fall short despite well-intentioned efforts by hospital staff. The new report explores how fragmented care settings and payment systems, unclear regulations, and information gaps all play a role in limiting the guidance hospital staff can provide patients and their families in arranging post-acute care.

The report, “Pathways to Progress on Difficult Decisions in Post-Acute Care,” offers a roadmap for tackling the obstacles that hinder informed decision-making. It outlines strategies for change in six key areas: engaging patients and families; improving discharge planning; bridging health system silos; addressing regulatory and payment policy barriers; enhancing public information and transparency; and increasing public awareness. Recommendations for improving the post-acute care process include clarifying legal restrictions that limit the advice hospital staff can provide during discharge planning and lifting the burden of research and decision-making placed on patients and families.

The “Difficult Decisions” series combines UHF’s research with input from patients and their families, health care providers, researchers, policymakers, and other stakeholders to identify promising approaches for supporting decision-making at discharge.

Difficult Decisions About Post-Acute Care and Why They Matter” (November 2018)

The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers” (January 2019)

Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility” (January 2019)