(Research Hub Theater) Functional Status Outcomes in Adults Discharged from Inpatient Rehabilitation Facility to Skilled Nursing Facility: A Longitudinal Observational Study

Background and/or Objectives: Inpatient Rehabilitation Facility (IRF) care has an inherent goal of discharging patients back into the community and some patients do not progress sufficiently to achieve that goal. No publications have addressed patient outcomes with IRF followed by care in a Skilled Nursing Facility (SNF), which could potentially be a solution to improve morbidity and mortality for those patients unable to discharge directly home from an IRF. Objective of this study is to identify functional outcomes of patients who receive combined rehabilitation from IRF and SNF.

Design: This is a longitudinal observational study. Living situation and aid requirement were assessed at 2 time points: prior to acute hospitalization and following discharge from SNF.

Setting: Inpatient Rehabilitation Facility

Participants: Persons who sustained severe injury requiring post-acute care stay at an IRF, and at time of discharge, were not yet safe to return home, and instead being admitted to a SNF.

Interventions: not applicable

Main Outcome Measures: A semi-structured phone call questionnaire evaluating changes in pre- and post-morbid functional status categorized by living situation and aid requirement.

Results: A convenience sample of 43 adults completed the study. 58.2% of respondents returned to baseline independence following stay at IRF followed by SNF. 63.4% who lived at home prior to acute hospitalization returned home following IRF and SNF stay.

Conclusions: Our findings indicate that those patients that receiving further rehabilitation at a SNF following discharge from an IRF can return to a baseline functioning and subsequently return home. Utilizing IRFs in conjunction with SNFs should be considered as an effective and patient-centered option for rehabilitation. However, future studies should explore how post-acute care transitions can be optimally managed to return patients home with their highest level of independence.