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The Influence of Prior Functional Status on Self-Care Improvement During a Skilled Nursing Facility Stay

  • Brian Downer
    Correspondence
    Address correspondence to Brian Downer, PhD, School of Health Professions, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
    Affiliations
    Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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  • Ioannis Malagaris
    Affiliations
    Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
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  • Chih-Ying Li
    Affiliations
    Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA

    Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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  • Mi Jung Lee
    Affiliations
    Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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  • Rachel Deer
    Affiliations
    Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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      Abstract

      Objectives

      Older adults' prior health status can influence their recovery after a major illness. We investigated the association between older adults’ independence in self-care tasks prior to a skilled nursing facility (SNF) stay and their self-care function at SNF admission, discharge, and the change in self-care function during an SNF stay.

      Design

      Retrospective study of 100% national CMS data files from October 1, 2018, to December 31, 2019.

      Settings and Participants

      The sample included 616,073 Medicare fee-for-service beneficiaries who were discharged from an SNF between October 1, 2018, and December 31, 2019.

      Methods

      The admission Minimum Data Set (MDS) was used to determine residents’ prior ability (independent, some help, dependent) to complete self-care tasks before the current illness, exacerbation, or injury. Seven self-care tasks from MDS Section GG were used to calculate total scores (range 7-42 points) for self-care at admission, discharge, and the change in self-care between admission and discharge.

      Results

      Most residents (62.0%) were independent, 35.3% needed some help, and 2.64% were dependent in self-care prior to SNF admission. Nearly 25% of residents with urinary incontinence, 28.8% with bowel incontinence, and 31.7% with moderate-severe cognitive impairment were independent in self-care prior to SNF admission compared with approximately 70% of residents without these conditions. Compared with residents who were dependent in self-care prior to SNF admission, those who were independent or needed some help had significantly higher self-care total scores at admission (5.67 vs 4.21 points, respectively) and discharge (6.44 vs 3.82 points, respectively) and exhibited greater improvement in self-care (3.48 vs 1.62 points, respectively).

      Conclusions and Implications

      Our findings are evidence that the new MDS item for a resident's independence in self-care tasks before SNF admission is a valid measure of their prior self-care function. This is clinically useful information and should be considered when developing rehabilitation goals.

      Keywords

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