Rehabilitation in skilled nursing facilities: effect of nursing staff level and therapy intensity on outcomes

Abstract

Objective: To explore the relationship of patients' outcomes with nursing staff levels and therapy intensity within skilled nursing facilities.

Design: Secondary analysis using administrative dataset of 6,897 patients from 68 skilled nursing facilities providing rehabilitation and reimbursed through Medicare+Choice. Independent measures were facility level nursing hours-to-resident ratio and total therapy hours per day. Outcomes included discharge to community and length of stay efficiency.

Results: Patients were 1.53 times more likely to be discharged to the community when nursing staff level was > or = 3.5 hrs per resident per day as compared with <3.5, and patients were 1.22 and 2.02 times more likely to be discharged to the community when therapy averaged 1-1.5 hrs/day and >1.5 hrs/day, respectively, as compared with <1 hr/day. The adjusted mean length-of-stay efficiency was 0.21 points greater in facilities where the nursing staff level was > or = 3.5 hrs per resident per day than in facilities where the level was <3.5 and 0.43 and 0.70 points greater in facilities where patients received 1-1.5 hrs/day and >1.5 hrs/day of therapy, respectively, than in facilities where the average therapy intensity was <1 hr/day.

Conclusions: Higher nursing staff levels and therapy intensity are related to improved length-of-stay efficiency and increase the likelihood of patients' being discharged to the community.