Comparing Post-Acute Care Outcomes Between Home Health Care and Skilled Nursing Facilities: A Scoping Review

Skilled nursing facilities (SNFs) and home health care (HHC) are 2 primary settings for post-acute care (PAC). There is growing interest in shifting care from SNFs to lower-cost home-based care, which may also be preferred by patients and families due to a more patient-centered approach.

This scoping review aimed to (1) identify conditions or populations for which SNF and HHC care models have been directly compared, and (2) assess outcome comparisons between SNF and HHC populations, with a focus on clinical measures and health care utilization.

Scoping review.

Adults aged ≥65 years living in the United States.

A search of PubMed and EMBASE was conducted from January 1, 1998, to October 15, 2024. Studies were included if they (1) focused on PAC, explicitly comparing SNFs and HHC, with HHC involving the receipt of care services; (2) reported patient-level clinical outcomes; (3) targeted older adult populations (aged ≥65 years); (4) examined the US health care system; and (5) were accessible in English. Titles and abstracts were screened independently by 2 reviewers, followed by full-text reviews to determine eligibility, with discrepancies resolved through consensus.

Six studies published between 2011 and 2024 met the inclusion criteria. Most studies focused on short-term (eg, 30-day) outcomes and older adults recovering from specific indications such as orthopedic surgeries. Outcomes included physical function, hospital readmissions, mortality, and costs. Although findings on hospital readmissions and functional outcomes were mixed, mortality rates showed no significant differences. Costs were consistently lower for HHC compared with SNFs.

Most comparative studies of HHC and SNF-based PAC focus on specific conditions for hospitalization, short-term outcomes, and claims-based measures. This review highlights the need for further research addressing broader clinical populations referred to SNFs or HHC and longer-term, patient-centered outcomes.