Factors associated with short- versus long-term skilled nursing facility placement among community-living hip fracture patients

Abstract

Characteristics associated with long-term placement among community-living patients admitted to a skilled nursing facility (SNF) after a hip fracture were identified. Subjects were 151 consecutive, elderly, community-living persons discharged from two acute hospitals to SNFs after surgery for a hip fracture. Medical, functional, psychological, social, and outcome data were collected from hospital and nursing home charts. Ninety-seven subjects (64%) were discharged home within 6 months; 50 (33%) became permanent SNF residents; and four died. Multiple logistic regression identified orientation, younger age, ability to bathe independently, family involvement, ability to ambulate or transfer independently, and greater number of available physical therapy hours as factors contributing independently to returning home. Likelihood of returning home increased from 7% among subjects with fewer than two of the patient characteristics to 82% among subjects with four or more characteristics (P less than .0005). These results suggest that hip fracture patients at high risk of permanent SNF placement can be identified at time of hospital discharge. Investigations are needed to determine whether more intensive rehabilitation and discharge planning may improve the chance of returning home for a large percent of hip fracture patients.