Post-Operative Care in Skilled Nursing and Long-Term Care

Abstract

Post-operative patients who are deemed unsafe for discharge home because of ongoing clinical needs not easily met in a home environment or those with social service challenges are often best served by skilled nursing facilities with programs that include restorative rehabilitation, long-term care, hospice, respite, and specialized units devoted to traumatic brain injury, dementia, dialysis, and mechanical ventilatory support. In addition to a facility’s ability to coordinate appropriate transitions of care, an understanding of payor sources, especially Medicare and Medicaid, is essential to appropriate patient placement. On-line resources of State and Federal benchmarks provide comparative data on quality measures of skilled nursing facility performance in areas such as occurrence of pressure injury to skin and use of psychotropic medications. Post-operative patients want to be sure to be placed in facilities with a known track record of caring for patients with their unique needs; this may include programs such as in-house availability for orthopedic follow-up or in-house vascular testing and specialized wound care. Expanded use of telehealth services in rehab and long-term care facilities has expanded the reach of surgical teams into patient centers for ongoing observation and clinical coordination of care.