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Don’t Delay Using Health Literacy in Your Care Planning and Discharge Planning Process

By Jessie McGill, RN, RAC-MT, RAC-MTA - September 15, 2020

Mrs. Elderberry is ready to go home. It’s been five long weeks of rehabilitation following a broken hip from that clumsy slip on a rug. Home. She’s wondering if her son actually watered her house plants that she proudly kept vibrant for years. Home. The nurse called her attention back to the medication list they were reviewing and asked which pharmacy she preferred. Mrs. Elderberry recited the name of the drugstore down the street and silently thought about enjoying coffee with the neighbor ladies. Maybe she could host this Sunday? Home. The nurse asked if she had any questions regarding her medications. She smiled and said no, thinking her son could explain it more clearly once she was home.


Discharge planning is an essential piece of a successful return to the community. However, assessing the resident’s health literacy is another critical piece that is necessary for effective planning. The U.S. Department of Health and Human Services (HHS) defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make an appropriate health decision. While the assessment of health literacy is not yet a required part of the resident assessment process in skilled nursing facilities (SNFs), it should still be incorporated into the care planning and discharge planning process.


In the SNF Prospective Payment System (PPS) Fiscal Year (FY) 2020 Final Rule, the Centers of Medicare and Medicaid Services (CMS) finalized health literacy as a Standardized Patient Assessment Data Element (SPADE). It stated, “low health literacy can interfere with communication between the provider and resident or patient and the ability for residents and patients or their caregivers to understand and follow treatment plans, including medication management. Poor health literacy is linked to lower levels of knowledge about health, worse health outcomes, and the receipt of fewer preventive services, but higher medical costs and rates of emergency department use.”