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Related Experiment Video

Updated: Apr 5, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Observation encounters and subsequent nursing facility stays.

Anita A Vashi¹, Susannah G Cafardi, Christopher A Powers

¹16 Laguna St, Apt 303, San Francisco, CA 94102.

The American Journal of Managed Care

|August 6, 2015

Summary

Few Medicare beneficiaries discharged from observation services went to skilled nursing facilities (SNFs), but many faced non-covered SNF stays. This highlights issues with Medicare

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Area of Science:

Health Services Research
Medicare Policy Analysis
Geriatric Care

Background:

Medicare coverage for skilled nursing facility (SNF) care mandates a 3-night inpatient hospital stay within 30 days.
Time spent under hospital observation services does not fulfill this SNF eligibility requirement.

Purpose of the Study:

To determine how often Medicare beneficiaries are discharged from hospital observation services to SNFs.
To assess the impact of these discharges on Medicare coverage.

Main Methods:

Retrospective cohort study design.
Analysis of Medicare beneficiary data from 2010.

Main Results:

195,068 community-dwelling beneficiaries received hospital observation services in 2010.
Most (96.5%) were discharged home without home health services.
Only 1.2% went to non-covered SNFs, and 0.6% to covered SNFs.
SNF discharges had longer observation lengths of stay (LOS) than community discharges (34.9 vs. 25.5 hours).
About 25% of SNF-discharged patients had observation LOS of 48 hours or more.

Conclusions:

A small proportion of Medicare beneficiaries discharged from observation were admitted to SNFs.
Discharges to non-covered SNFs present significant implications for patients and healthcare costs.
Findings underscore the need to review Medicare's observation services and 2-midnight policies.