SHM Converge Scientific Abstract ePoster Gallery-"Transitions Are Really Hard": Dementia Caregiver Perspectives on Hospital to Skilled Nursing Facility Transitions

Pdf Summary

This qualitative study examined how dementia caregivers अनुभव hospital-to-skilled nursing facility (SNF) transitions after hospitalization. Nineteen caregivers were interviewed at an urban SNF about preparation, the transfer process, and care experiences. The analysis identified four major themes.<br /><br />First, caregivers often felt inadequately prepared for the hospital-to-SNF transition. Many were unsure what to expect, worried about recovery, and felt they needed more communication and guidance from clinicians. Second, caregivers expected SNF stays to support functional recovery and eventual discharge home, but actual care often did not match these goals. They reported inconsistent or poorly timed therapy, communication problems, and the need to closely monitor care. Third, the transfer itself could be disruptive and stressful, especially when prolonged or poorly organized. Gaps in communication between hospital and SNF staff sometimes led to missed therapy and confusion. Fourth, dementia made transitions even more complicated because patients were more vulnerable to delirium, distress, and the need for caregiver presence.<br /><br />Overall, caregivers described hospital-to-SNF transitions as difficult and often inadequately supported. The findings suggest that better caregiver communication, more consistent rehabilitation access, and stronger coordination between hospital and SNF teams could improve the transition experience and support goal-concordant care for people living with dementia.

Asset Subtitle

Blair P. Golden

Meta Tag

Author List Blair P. Golden, James D. Harrison, Julia K. Axelrod, Margaret C. Fang, Nora Hutchinson, Rebecca L. Sudore

Category Research

Concept Hospital to Skilled Nursing Facility Discharge Handoff

Concept Dementia

Concept Caregiver

Concept Communication Gap

Concept Skilled Nursing Facility

Distinguished Non-Finalist

Presenter Organization Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health

Presenting Author Blair P. Golden

Track Transitions of Care

Keywords

dementia caregivers

hospital-to-SNF transitions

skilled nursing facility

caregiver communication

functional recovery

rehabilitation therapy

care coordination

delirium

hospital discharge

goal-concordant care

Hospital to Skilled Nursing Facility Discharge Handoff

Dementia

Caregiver

Communication Gap

Skilled Nursing Facility