Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults
Open Access
- 26 October 2017
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 66 (1), 100-105
- https://doi.org/10.1111/jgs.15150
Abstract
Background/Objectives Community‐based older adults are increasingly living alone. When they become ill, they might need greater support from the healthcare system than would those who live with others. There also has been a growing concern about the high use of postacute care such as skilled nursing facility (SNF) care and the level of variation in this use between hospitals and regions. Our objective was to examine whether living alone contributed to the risk of being discharged to a SNF. Design Retrospective cohort study. Setting Massachusetts General Hospital. Participants Community‐dwelling individuals aged 50 and older admitted to the medical service and discharged alive between July 2014 and August 2015 (N = 7,029). Measurements We extracted demographic, clinical, and functional data from the electronic medical record and used multivariable logistic regression to determine whether living alone at the time of hospitalization was associated with subsequent discharge to a SNF. Results Of eligible individuals, 24.8% reported living alone before admission. Those living alone were more likely to be female, older, and more independent before admission than those living with others. Of all participants, 10.9% were discharged to a SNF. After adjustment, participants living alone had more than twice the odds of being discharged to a SNF (odds ratio = 2.23, 95% confidence interval = 1.85–2.69, P < .001). Discussion People living alone are more likely to be discharged to SNFs, even when compared to other individuals with similar levels of clinical complexity and functional status. To the extent that this variation is due to a lack of home support, it could be possible to reduce SNF use through additional home services after hospital discharge.This publication has 35 references indexed in Scilit:
- Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older AdultsJournal of the American Geriatrics Society, 2016
- Do hospital-owned skilled nursing facilities provide better post-acute care quality?Journal of Health Economics, 2016
- Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture?PTJ: Physical Therapy & Rehabilitation Journal, 2016
- Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility AdmissionJournal of the American Medical Directors Association, 2015
- Volume Matters: Returning Home After Hip FractureJournal of the American Geriatrics Society, 2015
- Patient and Hospitalization Characteristics Associated With Increased Postacute Care Facility Discharges From US HospitalsMedical Care, 2015
- AM-PAC “6-Clicks” Functional Assessment Scores Predict Acute Care Hospital Discharge DestinationPTJ: Physical Therapy & Rehabilitation Journal, 2014
- MEDICARE SKILLED NURSING FACILITY REIMBURSEMENT AND UPCODINGHealth Economics, 2013
- Medicare prospective payment and the volume and intensity of skilled nursing facility servicesJournal of Health Economics, 2011
- A Comparison of Skilled Nursing Facility Rehabilitation Treatment and Outcomes Under Medicare Managed Care and Medicare Fee-for-Service ReimbursementThe Gerontologist, 2000