Rehabilitation in skilled nursing facilities - Effects of nursing staff level and therapy intensity on outcomes

Objective: To explore the relationship of patients' outcomes with nursing staff levels and therapy intensity within skilled nursing facilities. Design: Secondary analysis using administrative dataset of 6,897 patients from 68 skilled nursing facilities providing rehabilitation and reimbursed through Medicare+Choice. Independent measures were facility level nursing hours-to-resident ratio and total therapy hours per day. Outcomes included discharge to community and length of stay efficiency. Results: Patients were 1.53 times more likely to be discharged to the community when nursing staff level was greater than or equal to3.5 hrs per resident per day as compared with <3.5, and patients were 1.22 and 2.02 times more likely to be discharged to the community when therapy averaged 1-1.5 hrs/day and >1.5 hrs/day, respectively, as compared with <1 hr/day. The adjusted mean length-of-stay efficiency was 0.21 points greater in facilities where the nursing staff level was greater than or equal to3.5 hrs per resident per day than in facilities where the level was <3.5 and 0.43 and 0.70 points greater in facilities where patients received 1-1.5 hrs/day and >1.5 hrs/day of therapy, respectively, than in facilities where the average therapy intensity was <1 hr/day. Conclusions: Higher nursing staff levels and therapy intensity are related to improved length-of-stay efficiency and increase the likelihood of patients' being discharged to the community.