Achieving Functional Goals During a Skilled Nursing Facility Stay: A National Study of Medicare Beneficiaries.
Brian Downer, Megan Wickliff, Ioannis Malagaris and 2 others
PMID 38112630WHAT IT FOUND
Fewer than half of skilled nursing facility residents met their documented discharge goals for self-care and mobility.
Residents aged 90+, those with cognitive impairment, amputations, or incontinence had significantly lower odds of meeting these goals compared to younger, orthopedic patients.
Key findings
01Overall, 43.9% of residents had a total discharge performance score equal to or greater than their total goal score.
02Residents aged 90 and older had 0.61 lower odds of meeting or exceeding their total goal score than those aged 65–69.
03Compared to residents admitted for an orthopedic condition, residents with an amputation had the lowest adjusted odds for meeting or exceeding discharge goals (OR=0.60).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The analysis was restricted to residents who survived their SNF stay and had a planned discharge to a non-acute setting, excluding those who died or returned to the hospital. The study required valid goal scores for all eight specific self-care and mobility items, excluding residents with fewer documented goals or those with 'not attempted' codes. The total score summed self-care and mobility items, meaning a resident could meet a goal for one item but miss it for another, yet still be categorized as not meeting the total goal. The study could not account for individual patient preferences or the specific content of goal-setting conversations, only the documented scores.
Declared interests
The study was supported by the National Institute on Aging (NIA) of the National Institutes of Health (NIH). The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret the high rate of goal documentation as evidence that goals are being set realistically or achieved. The study shows that while facilities document goals for over 70% of residents, fewer than half actually meet those goals, and the gap is largest for the most vulnerable patients.