Readmission Risk Coming Home After Rehabilitation in a Skilled Nursing Home With Dementia

Community dwelling people living with dementia (PLWD) are more likely to visit a skilled nursing home (SNH) after an acute hospital stay and have a high risk of readmission to the hospital. Staff in SNHs have familiarity with caring for PLWD that may mitigate readmissions, but dementia's role in readmissions for this high risk population remains unclear.

Using Health and Retirement Study data linked to Medicare claims between 2000 and 2019, this study aimed to investigate the role of dementia in hospital readmissions after a short rehabilitative stay (< 100 days) in the nursing home. Event-level data was analyzed for risk of 30-day hospital readmission following SNH discharge to the community using first Generalized Estimating Equations to estimate individual variables' association with readmission and then constructing a regression model to estimate the risk of readmission to the hospital using adjusted odds ratios.

There were 714 readmissions to the hospital out of 4527 discharges to the community following SNH stay (15.8%). A dementia diagnosis identified by Medicare claims, present for 42.2% of the population, was not associated with hospital readmission. Female sex, being married, and living in the Midwest or Western United States were associated with lower odds of readmission. Hospital or emergency department visits in the year prior to the index SNH admission and higher Charlson comorbidity scores were associated with higher odds of post-SNH discharge 30-day readmission.

A formal dementia diagnosis may serve as a signal to SNHs to provide enhanced support in their discharge processes. Intrinsic factors related to the patient's health status such as prior hospital use and comorbidity burden, in addition to social support factors such as marital status, play the greatest role in readmission risk. These characteristics should be recognized and mitigated by discharge planners, policy makers, and insurers making care coverage decisions.