Volume 53 | Number 6 | December 2018

Abstract List

Denise A. Tyler Ph.D., John P. McHugh Ph.D., M.B.A., Renee R. Shield Ph.D., Ulrika Winblad Ph.D., Emily A. Gadbois Ph.D., Vincent Mor Ph.D.


To identify the challenges that reductions in length of stay () pose for skilled nursing facilities (s) and their postacute care () patients.

Data Sources/Setting

Seventy interviews with staff in 25 s in eight cities, data for patients in those s.

Study Design

Data were qualitatively analyzed, and key themes were identified. Interview data from s with and without reductions in median risk‐adjusted were compared and contrasted.

Data Collection/Extraction Methods

We conducted 70 semistructured interviews. data were derived from minimum dataset () admission records available for all patients in all s from 2012 to 2014.

Principal Findings

Challenges reported regardless of reductions in included frequent and more complicated re‐authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced included s being pressured to discharge patients within certain time limits. Some s reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities.


The push for shorter has resulted in unexpected challenges and costs for s and possible unintended consequences for patients.