Implications for long-stay resident independence when nursing homes increase rehabilitative care for short-stay residents

Nursing homes (NHs) are increasingly serving short-stay rehabilitation residents under Medicare’s skilled nursing facility (SNF) benefit, which is substantially more generous than Medicaid payment for long-stay NH residents. Previous research suggests that increasing SNF care may have beneficial spillover effects for a NHs’ long-stay residents’ independence in activities of daily living (ADLs), but such effects have not been examined. The objective of this study is to examine how changes in the proportion of SNF days in NHs relates to changes in long-stay residents’ need for help with late-loss ADLs (bed mobility, transfer, eating, and toileting). An observational cohort was constructed using publicly available data on NHs certified by the Centers for Medicare & Medicaid Services. We used panel multivariate regression analyses with facility fixed-effects (2007 to 2010). The sample includes 11,974 NHs present in the dataset all four years and reporting on ADL decline in at least two of those years. Findings show increasing the proportion of SNF days in a NH is associated with reductions in the proportion of long-stay residents whose need for help with ADLs has increased (p<.05). This information can help NH providers gauge how to balance diverse service offerings for optimal value, and motivates research on how different balances of long-stay and short-stay residents relate to NH performance on different measures, including measures of long-stay and short-stay resident outcomes. Additional research is needed to specify the mechanisms driving the identified reductions, such as increasing staff exposure to rehabilitative care and increasing nursing home financial resources.