SNF Prediction Tool Could Keep Home Health Diversions High

A risk tool that makes it possible to accurately predict which hospital patients will end up being discharged to a skilled nursing facility (SNF) could lead to more care being shifted into the home.

That’s according to a recent study published in the June issue of JAMDA.

Conducted by researchers from Massachusetts General Hospital, Harvard Medical School and the University of California, the study examines health data linked to 11,380 hospitalized patients in order to identify predictors of SNF discharge.


As part of the study, researchers additionally factored in socio-demographic variables such as age, marital status, gender, admission day and admission location. Researchers likewise reviewed admission diagnoses and patients’ general living situations.

Overall, researchers found that any impairments in mobility or bathing at hospital admission were significant predictors of SNF discharge.

Broadly, the study’s findings could help guide clinicians, administrators and policymakers when making decisions about care transitions moving forward — and whether home health services or a SNF stay are best for a patient’s recovery.


Currently, transitions of care remain troublesome for health care providers across the continuum, partly due to limitations placed on discharge planners, according to the Medicare Payment Advisory Commission (MedPAC).

In the study, researchers noted that, in cases where the main reason for SNF discharge is the lack of home support, the ability to identify family and community resources early would allow hospitals to send those patients directly home.

“There is increasing evidence that discharge to post-acute facilities is often influenced by non-skilled needs (e.g. availability of caregiver, marital status and living alone),” the researchers wrote. “It therefore follows that the successful identification of patients at risk for SNF discharge will require more than the evaluation of traditional administrative and clinical data; rather, it requires an assessment of the patient’s functional status, social support, and living situation as well.”

Over the years, health care policymakers have attempted to contain spending by moving care away from hospitals, SNFs and other higher-acuity settings by shifting it into the home.

Meanwhile, home health providers have positioned their operations to handle more acute patients traditionally served in SNFs over the past few years, contributing to an overall reduction in SNF length of stays.

But some industry experts believe the tide of SNF to home diversion has turned.

They include George Hager, CEO of Genesis HealthCare (NYSE: GEN), a Kennett Square, Pennsylvania-based holding company with subsidiaries that include more than 400 skilled nursing centers and senior living communities across the U.S.

“To anyone [who] would want [to] or has toured a skilled nursing asset, I would challenge you to look at the patients in our building and find patients that could be cared for in a home-based or community-based setting,” Hager said while speaking at the Barclays Global Healthcare Conference in March. “The acuity levels of an average patient in a skilled nursing center have increased dramatically.”

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