OTRNCohortJournal of the American Medical Directors Association2025

Skilled Nursing Facility Population Characteristics and Length of Stay: A Prospective Cohort Study.

Morgan C Byrd, Anna Stark, Jennifer Head and 5 others

PMID 40912675

WHAT IT FOUND

Residents dependent in daily activities and those with vascular or surgical devices stayed longer in a skilled nursing facility; dependence in daily activities was the strongest factor tied to longer stays.

Key findings

01ADL dependence was the strongest predictor of longer length of stay (HR 1.63; 95% CI 1.42 to 1.86), followed by having a vascular access or surgical drain device (HR 1.37; 95% CI 1.09 to 1.73).

02Residents with all high-risk characteristics (younger than 70 years, no heart disease, antibiotics during the study, ADL dependent, and a vascular or surgical device) had mean stays 15.8 days longer at the 25th percentile, 23.5 days longer at the 50th percentile, and 34.9 days longer at the 75th percentile than residents with all low-risk characteristics.

03Age did not differ significantly across length-of-stay categories, but faster discharge was more frequent among residents 80 years and older, and residents aged 70 years or younger had the longest stays.

STILL TO COME

How it was doneWhat they foundWhat it means for OTsWhat it means for RNs

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What it does not show

The study was done in one nonprofit skilled nursing facility in a predominantly White community, so the results may not apply to other SNFs, especially for-profit or lower-resource facilities. Many health characteristics were collected only at enrollment, so the study could not account for improvement in frailty or ADL status during the stay. The study was observational, so it shows associations with length of stay, not that changing ADL dependence or removing a device would shorten stay. Movement and visitor patterns were affected by pandemic masking and social distancing, so they may not reflect usual SNF life. Reasons for prior hospitalization were recorded only as general diagnostic categories, so the analysis could not adjust for why residents needed SNF care.

Declared interests

The authors declared no conflicts of interest. The article is listed as supported by non-U.S. government research funding.

The easy way to misread this

Do not read ADL dependence or device presence as causes of longer stay. This was an observational cohort in one facility, and no treatment or care process was tested.

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