Another significant factor delaying discharge: the funding process for home care, assisted living, or skilled facility care. Once a patient is ready to transition (or very close), many patients need to apply for specific insurance to cover that kind of care, which is not automatic under most plans. (Just because it was considered medically necessary by a multidisciplinary team doesn't mean it was covered... but your hospital stay? That's definitely decertified now, because the team is recommending transfer to a different level of care.) The state can take 30 days to review that application once all the materials are pulled together - and it essentially -always- takes 28-30 days.  Assisted living and skilled nursing applications aren't reviewed until that funding is in place as they are in no position to hold beds indefinitely.
This leads to a 2-4 week extension of hospital time on these stays, & it's not something anyone wants.