Optimizing social risk screening for hospitalized older adults preparing for postacute care: A patient-perspective qualitative usability study of the Assessing Circumstances and Offering Resources for Needs screening tool.

Abstract

Identifying social risks and addressing social needs during hospitalization is essential to improving safe discharge and postacute care (PAC) planning. Older adults often report unmet needs that impact recovery, yet existing screening tools are not tailored to inpatient settings. Assessing Circumstances and Offering Resources for Needs (ACORN) is a standardized Department of Veterans Affairs (VA) intervention designed to identify social risks and address social needs. To evaluate ACORN's usability and acceptability among hospitalized older adults likely to require PAC, identify patient-informed adaptations for inpatient discharge planning, and describe prevalence of social needs. This qualitative study included ACORN administration and usability interviews. Participants include older adults (age 60 + ) at three urban hospitals-two VA and one non-VA academic centers-identified by inpatient teams as likely to need PAC. Thirty-two participants (mean age = 72; 81% male; 81% Veterans) completed interviews. Most (88%) endorsed at least one social need. Participants described ACORN as acceptable, straightforward, and relevant for discharge and PAC planning, noting that it helped them reflect on recovery needs and could enhance communication with their care team. Social needs were highly prevalent among hospitalized older adults likely to require PAC. Participants viewed the ACORN screening tool as acceptable, usable, and relevant to postacute planning. These patient-informed insights underscore the need to integrate social-risk screening in ways that align with patients' preferences to better support PAC planning and care transitions.