{"doi":"10.1111/jgs.17595","title":"Case management in a <scp>COVID</scp> ‐19 surge: A <scp>single‐institution</scp> study of disposition and access to <scp>post‐acute</scp> care","abstract":"Patients hospitalized with coronavirus disease 2019 (COVID-19) have demonstrated significant care needs after discharge, particularly among older adults and those with preadmission frailty.1 Characteristics and outcomes of patients hospitalized with COVID-19 have been well described,2 but few studies have examined patterns in post-acute care (PAC) utilization over the course of a COVID-19 surge.3 Evaluating these trends may inform planning for future surges. During the initial COVID-19 surge, PAC facilities and resources were limited due to lack of personal protective equipment, internal COVID-19 outbreaks, and staffing shortages. To address these shortages in Boston, Massachusetts, PAC sites for patients with COVID-19 were created, including Boston Hope Field Hospital4 and dedicated units at skilled nursing facilities (SNFs) in the community.5 We describe patterns in PAC utilization, including placement in PAC facilities (SNFs, long-term acute care [LTAC], and inpatient rehabilitation [IRF]) and referral to home health agencies (HHAs) among patients aged 50 years or older with COVID-19 at a tertiary care, 1043-bed, hospital in Massachusetts. Patients aged 50 years or older with COVID-19 admitted during the 12-week (March 11, 2020–June 3, 2020) surge were included. Patients admitted from PAC facilities (including short-stay and long-term care) prior to their acute hospitalization were excluded. We used data from the MGH COVID-19 Data Registry6 and 4Next, a case management application, to evaluate trends in discharge disposition relative to the opening of dedicated COVID-19 PAC facilities. A total of 836 patients were included in the cohort. The mean age was 69 years. Most patients self-identified as White (44%) or Hispanic (30%), and 40% had limited English proficiency. While many were admitted from private homes (77%), a significant portion (13%) presented from assisted living facilities. Approximately one third (35%) of patients had an intensive care unit (ICU) stay, 85% of whom were intubated. The median length of stay (LOS) was 8 days, and the mean LOS was 14. Half of the patients (50%) were discharged to home, but less than one third of those discharged home (16% of total) received HHA services. Approximately one third (31%) were discharged to a PAC facility. The majority of PAC discharges (17% of total) were to LTACs as compared to SNFs (10% of total) and IRFs (4% of total). In the initial 6 weeks, 35% of the cohort was discharged to PAC facilities or home with HHA services (Figure 1A). This increased in concert with the opening of dedicated COVID-19 PAC sites to 59% over the remainder of the surge. In the final weeks, when fewer patients with COVID-19 were discharged, nearly 60% were discharged to PAC facilities and no patients were discharged home without HHA services. SNF referrals for all hospitalized patients peaked to an average of 15 referrals per patient from a pre-pandemic average of four (Figure 1B). During this COVID-19 surge, hospitalized adults aged 50 years or older with COVID-19 faced significant PAC challenges including limited access and increased PAC needs. As the pandemic emerged, considerable attention was paid to anticipated acute inpatient needs; however, preparation for PAC use was less robust.7 Few facilities accepted patients with COVID-19 initially and many were unable to operate at capacity. Our referral findings suggest that access to SNFs was severely limited during the COVID-19 surge and that this improved over time as auxiliary discharge locations opened. In addition, strict admission requirements to LTAC and IRF8 were waived to facilitate movement of patients across the care spectrum as seen in our cohort. PAC needs remained high compared to a pre-pandemic baseline. For all-payer discharges in Massachusetts in 2016, 18% of all patients were discharged to PAC facilities9 as compared to 31% in our cohort. Early in the surge, most patients were discharged home without HHA services. Over time,","journal":"Journal of the American Geriatrics Society","year":2021,"id":210105,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9635,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":728983,"name":"Benjamin P. Geisler","orcid":"0000-0003-1704-6067","position":1,"is_corresponding":false},{"id":798690,"name":"Donna Rusinak","orcid":null,"position":2,"is_corresponding":false},{"id":263592,"name":"Ingrid V. Bassett","orcid":"0000-0001-6920-6080","position":3,"is_corresponding":false},{"id":263596,"name":"Virginia A. Triant","orcid":"0000-0001-5288-6067","position":4,"is_corresponding":false},{"id":798691,"name":"Rachael McKenzie","orcid":null,"position":5,"is_corresponding":false},{"id":382112,"name":"Melissa L. P. Mattison","orcid":null,"position":6,"is_corresponding":false},{"id":798199,"name":"Amy W. Baughman","orcid":"0000-0002-1275-3769","position":7,"is_corresponding":false},{"id":798198,"name":"J O'Neil","orcid":"0000-0002-2459-2309","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-18T23:52:08.869117Z","pmid":"34817856","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}