Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults

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.

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

“…Policy solutions have traditionally been directed at rationalizing payment across populations, geography, setting, and time (27–29). Our study contributes to an emerging body of evidence emphasizing the need to better coordinate health care and community-based long-term services and supports (30, 31) and the potential cost savings of assessing and addressing the care needs of high-risk sub-populations (32–35).…”

Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study

“…23,24 Social isolation, a need that was addressed through our intervention, has also been linked to much higher rates of post-acute care in rehabilitation facilities. 25 Nursing home admissions among socially and medically complex Medicaid patients are known to be particularly sensitive to interventions and services that help patients live independently at home and connect with community resources. 26,27 These and other social factors associated with skilled nursing and rehabilitation visits may have been ameliorated through the social needs program in this study.…”

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

“…The lack of help at home from the patient’s partner has also been found to increase the likelihood of discharge to post-acute care instead of home discharge [ 34 ] while transfer to another hospital was associated with longer length of stay (unadjusted) [ 28 ]. Particularly among older patients, those living alone have been found to stay longer in hospital [ 35 ], to have higher odds of non-home discharge [ 35 ] and higher odds of discharge to skilled nursing facility care [ 36 ] compared to those living with others.…”