Table 3.

Participants description of constraints of insurance in transitioning patients to SNFs

Theme	Quotations	Role
2. Constraints of Insurance in Treatment and Discharge Disposition Choice	A. They told me that because of some rules in Medicare, that I would probably have to spend three days in the hospital before I can get into one of those places, and then I might not be able to get in because they may be full because they’re not that large of places…with that many empty beds.	University Patient
	B. Yeah, the only thing that throws us off is insurances, based on what they’re going to allow us to treat for.	SNF Physical Therapist
	C. If they are very limited with insurance options, and I know that those insurance option choices are not gonna give them a great experience, that’s hard… for me because then you’re operating on such a limited amount of choice.	University Social Worker
	D. “Well, if they’re not progressing once they get to that setting then it’s no longer going to be covered by insurance. They will cover them under their Medicare A days for X amount of time, then they go into their copay days, but ultimately, if they’re not demonstrating certain progress, then they’re not going to be able to stay in that setting.”	Hospital Occupational Therapist
	E. …. you can…get the patient on long-term Medicaid, so that means instead of…going to a rehab facility to get rehab, they will go to like a nursing facility to get just care… we know that they really need rehab, but their insurance doesn’t pay for rehab and yet they can’t go home because family can’t take care of them so then we send them to a facility for 30 days knowing that they’re not going to get a lot and that’s hard, so yes, they’re safe because they are not at home and somebody is caring for them “24 hours a day” but they’re deconditioning more because now they’re laying in a bed and so that’s one of those, too. It just doesn’t feel great, but it’s the best option? So it’s kind of like OK, this is the lesser of two evils so we’ve gotta go with it.	University Social Worker
	F. “I would be eligible for going to a civilian rehab…if I had Medicare I guess it is…when she [the social worker] found out I didn’t have it, then she said well then your only option really is the CLC [Community Living Center]”	VA Hospital Patient
	G. It’s finding a bed that works with that person’s insurance, it’s getting the insurance authorizations, so there’s constant barriers that we might be facing or you know, they have a bed available but after this whole process with getting insurance authorization, now that bed is no longer available.	Hospital Social Worker