Access to post-acute care has become severely challenged in recent years due to commercial insurance obstacles, workforce and bed shortages, and prolonged legal proceedings, among numerous other factors that fall at the feet of hospital case managers and other providers.

Post-acute care plays an outsized role in creating a more coordinated and seamless healthcare experience for patients. These services, including rehabilitative and skilled nursing care, support people following a hospital stay, providing the specialized follow-up care they need to continue healing and regain independence. When patients cannot access these settings, the effects reverberate throughout the entire healthcare system.

That’s why MHA and our post-acute partners are supporting state reforms that would ease patient roadblocks and give providers the additional supports the need.

A Clogged System

Each month, MHA measures the number of patients who are “stuck” in hospitals awaiting discharge to the next level of care. In April, there were 2,103 patients in 48 reporting acute care hospitals that were awaiting transfer. 240 patients were waiting more than 30 days for post-acute services.

While those patients cannot access the specialized post-acute care they need, they also occupy a bed that is needed for other patients in need of hospital-level care, driving up wait times.

The top reasons for the delays, as reported by hospital case managers, included:

• Private insurance administrative barriers
• Insurer does not provide post-acute coverage
• Lack of guardianship, conservatorship, or healthcare proxy

A Statewide Solution

An Act improving access to post-acute services, filed by Rep. Thomas Stanley (D-Waltham) and Sen. Pavel Payano (D- Lawrence), would make permanent the current expedited prior authorization pilot program for post-acute discharges that is anticipated to sunset in 2026. It would create a complex care case manager program to assist with hospital discharges, address pressure points in the legal process for patients without healthcare guardians, and introduce a range of supports for post-acute care hospitals themselves.

Access to post-acute care services is what has enabled my patient in his 70s to return to living independently in a third-floor walk-up in South Boston after a stroke. It is what enabled my patient who suffered a catastrophic brain bleed in her 40s and lives outside Springfield, MA to attend her daughter’s college graduation and return home to live with her family as she slowly recovered additional motor function and speech ability.

And it is key to what has enabled my patient in her 50s on the North Shore who sustained a high-level spinal cord injury in the 1990s to remain un-hospitalized since the time of her initial injury, avoiding costly and preventable readmissions over the past three decades and allowing her to live a meaningful and connected life enriched by community supports. Post-acute care has allowed her to become extremely skilled at monitoring her own health and built her confidence at directing her own care within the community and advocating for herself.

Chloe Slocum, MD, MPH
Director of Health Policy
Spaulding Rehabilitation

Snapshot: Skilled Nursing Facility Challenges

At MHA’s recent Post-Acute Care Summit, experts highlighted how these facility-level issues are compounded by broader systemic barriers.

“Despite best efforts and investments in nursing facility care, we continue to face significant workforce challenges—an urgent need to hire 4,400 direct care and clinical staff—and financial pressures, with a statewide operating margin of -1.6%. All this, while 91% of beds remain in use.”

Tara Gregorio
President,
Massachusetts Senior Care Association

According to the Massachusetts Senior Care Association’s Annual Care Transition Survey, the top three barriers skilled nursing facilities face in accepting discharges are:

1. Lack of available appropriate beds
2. Financial and insurance constraints
3. No appointed decision-maker (e.g., conservator or proxy)

Many patients also face roadblocks when trying to return to the community after a short-term stay in post-acute settings, including:

• No safe or secure housing
• Limited home supports or transportation
• Limits on length of stay or discharge timing
• Delays in home care services