Examining Trends in Nursing Home Placement Following Traumatic SCI: Insights From the National SCI Model Systems...

Area of Science:

• Rehabilitation Medicine
• Spinal Cord Injury Research
• Public Health

Background:

• Traumatic spinal cord injury (tSCI) necessitates extensive inpatient rehabilitation.
• Discharge disposition significantly impacts long-term outcomes and independence for tSCI survivors.
• Understanding trends in nursing home placement is crucial for resource allocation and patient care.

Purpose of the Study:

• To analyze and compare the trends in nursing home discharge rates among individuals with tSCI from 1970 to 2019.
• To identify demographic and clinical factors associated with nursing home placement after inpatient rehabilitation for tSCI.

Main Methods:

• Retrospective analysis of the national Spinal Cord Injury Model Systems (SCIMS) database.
• Inclusion of 33,379 individuals admitted to SCIMS centers between 1970 and 2019.
• Examination of discharge disposition to nursing homes following inpatient rehabilitation for incident tSCI.

Main Results:

• The rate of nursing home discharge increased from 3.6% in the 1970s to 9.5% in 2010-2019.
• This rate plateaued over the last two decades, despite increasing average age at injury and shorter rehabilitation lengths of stay.
• Older age, male sex, unemployment/unmarried status, complete tetraplegia, bladder dysfunction, ventilator dependence, and longer length of stay were associated with higher odds of nursing home discharge.

Conclusions:

• Nursing home discharge rates for tSCI patients have stabilized at approximately 9.5% over the past two decades.
• Despite changing demographics and shorter rehabilitation stays, key predictors of nursing home placement include age, injury severity, functional limitations, and social factors.
• Individualized discharge planning and investment in community-based support are essential to promote independence and reduce institutionalization for individuals with SCI.