Abstract
Objective
To examine the distribution of admission and discharge functional abilities among
Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay.
Further, to assess the validity of the standardized discharge self-care and mobility
data by examining their association to community discharge.
Design
Observational study of SNF Medicare fee-for-service residents’ self-care and mobility
scores at admission and discharge.
Setting and Participants
Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified
SNFs.
Methods
We calculated self-care and mobility score frequencies and percentages at admission
and discharge to describe the functional abilities of SNF residents; we examined discharge
scores by percentage discharge to the community to evaluate item construct validity.
Results
Between admission and discharge, SNF resident scores showed overall improvements in
function for all self-care and most mobility activities. For example, between admission
and discharge the percentage of residents independent with toileting hygiene and sit
to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but
2 data elements, residents with lower functional abilities had a lower percentage
of being discharged into the community, and the percentage of residents discharged
into the community increased as residents performed functional activities of self-care
and mobility at higher score ratings. There was a consistent monotonic relationship
between residents’ discharge self-care and mobility scores and community discharge
rates for all but 2 data elements.
Conclusions and Implications
Our study found measurable improvements for each self-care and mobility function item
for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive
association between higher discharge self-care and mobility scores and higher discharge
to community rates. These findings support the validity of the data elements in measuring
functional abilities among SNF Medicare Part A residents.
Keywords
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