Skilled Nursing Facilities
Jette,D., Warren, R. and Wirtalla, C. (2004) Rehabilitation in Skilled Nursing Facilities- Effect of Nursing Staff and Therapy Intensity on Outcomes. American Journal of Physical Medicine and Rehabilitation; 83: 704-712
Objective: To explore the relationship of patient outcomes with nursing staff hours-to-resident ratio and therapy intensity within skilled nursing facilities (SNFs).
Design: 6, 897 patients from 68 SNFs were analized. Independent measures were facility level nursing hours to resident ratio as reported to Medicare and total therapy hours per day. Outcomes included dc to community and length of stay efficiency
Results: Patients were 1.8 (95% CI, 1.50-2.10) times more likely to be discharged to the community when nursing hours-to-resident ratio was ≥3.5, and 1.7 (95% CI, 1.27-2.39) times more likely where therapy averaged at least 1 hour and 15 minutes per day than for facilities averaging less than 45 minutes per day. The odds of patients being discharged requiring minimal assistance or less for daily functions were 1.5 (95%CI, 1.28-1.76) times greater in facilities with higher nursing hours-to-resident ratios and were 1.6 (95%CI,1.22-2.02), 2.5 (95%CI, 1.89-3.26), and 1.9 (95%CI, 1.37-2.60) times greater in each of the three categories of therapy intensity above 45 minutes per day. The adjusted mean LOS efficiency was 0.22 points greater in facilities where the nursing hours-to-resident ratio was ≥3.5 (P<.05), and greater in facilities where patients received 45 minutes of therapy per day or more (1.28, 1.33 and 1.58 vs. 0.95 points per day, P<.05).
Conclusion: Higher nursing hours-to-resident ratio and therapy intensity are related to improved LOS efficiency and increase the likelihood of patients’ living in the community and having a functionally meaningful level of independence.
Relevance: Health plans should monitor the amount of therapy provided under contracted per diem rates
