Implementation of Post‐Acute Rehabilitation at Home: A Skilled Nursing Facility‐Substitutive Model - American Geriatric Society

OBJECTIVES

For patients who require frequent and intensive therapy services after hospitalization, rehabilitation is predominantly provided in skilled nursing facilities (SNFs). Delivering post‐acute rehabilitation in patientsʼ homes offers a potential alternative. Our aim was to describe and evaluate services and functional outcomes and then identify factors associated with the provision of a 30‐day post‐acute care (PAC) bundle of rehabilitation, medical, and social services provided via the Rehabilitation at Home (RaH) program.

DESIGN

Single‐arm retrospective review of patients participating in the RaH program.

SETTING

Multidisciplinary home‐based delivery of PAC in Manhattan.

PARTICIPANTS

Individuals 18 years or older residing in a specified catchment area and qualifying for SNF‐based rehabilitation services from October 2015 to September 2017.

RESULTS

A total of 237 patients participated in RaH over 264 episodes of care. Participants were predominantly older than 85 years (57%; mean = 84.2; standard deviation [SD] = 10.0 years) and of non‐Hispanic white (70%) race and ethnicity. Most were admitted after hospitalization (88.2%) for 117 different diagnostic related groups. Average length of stay in RaH was 14.2 (SD = 6.5) days with patients receiving 1.83 (SD = 2.22) medical provider, 1.67 (SD = 1.58) nursing, and 5.24 (SD = 1.05) physical therapist visits weekly. Most of the patients fully or almost fully met their goals for bed mobility (65%), bed transfer (69%), chair transfer (67%), and ambulation (64%) with the majority achieving moderate or considerable (61%) global functional improvement. Achieving moderate or considerable global improvement was negatively associated with dementia diagnosis (odds ratio [OR] = .23; 95% confidence interval [CI] = .08‐.71) and positively associated with higher baseline ambulation (OR = 5.51; 95% CI = 2.22‐13.66). At 30 days, 87.3% of participants were living in the community.

CONCLUSION

Delivering SNF‐level post‐acute rehabilitation care in patientsʼ homes for a broad range of diagnoses is feasible and associated with functional improvement. This approach may help older adults maintain living status in the community.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KHANYO
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