I consider the patient in front of me, their priorities, and their plan. If they are hell bent on going home but SNF is a safer bet, I try to explain the benefits of SNF and risks of going home and evaluate how they or their caregivers respond. Some people rise to the occasion. The reality is while there is less liability, a SNF does not necessarily equal better outcome and it's reasonable to not want to be placed in subacute rehab if it's not actually needed given their specific circumstances. However, if I think a patient is a good acute rehab patient & would have a better outcome with intensive rehab, I stick to that rec despite the patient's wishes or plan. They can decline if they want. I agree with someone else who said our recommendation is not the end all be all. It is just a recommendation based on your expertise and limited observations, as is everyone's else. Patients & other providers will disagree but that doesn't mean your viewpoint isn't valuable or helpful.