From the Guidelines
Skilled Nursing Facility (SNF) care generally benefits patients who need specialized medical care and rehabilitation services that cannot be provided at home, as it provides consistent medication management, wound care, and monitoring of vital signs by trained healthcare professionals 1.
Benefits of SNF Care
The benefits of SNF care include:
- 24-hour nursing supervision
- Physical therapy
- Occupational therapy
- Speech therapy
- Personalized care plans that evolve as the patient's condition improves However, SNF care can potentially harm patients through risks of healthcare-associated infections, medication errors, falls, and psychological impacts of institutionalization 1.
Quality of Care
The quality of care varies significantly between facilities, with better outcomes generally seen in facilities with:
- Higher staffing ratios
- Specialized rehabilitation programs
- Comprehensive care coordination For optimal results, patients and families should carefully evaluate SNF options, considering factors such as:
- Staff-to-patient ratios
- Cleanliness
- Rehabilitation services offered
- Proximity to family members who can visit regularly and participate in care planning 1.
Management of Heart Failure in SNFs
The management of heart failure in SNFs should be patient-centered, highly individualized, and based on shared decision-making between a knowledgeable, well-coordinated, proactive healthcare team and informed patients or family 1.
Key Recommendations
Key recommendations for HF management in SNFs include:
- Initial management of volume overload is appropriate in the SNF
- Decisions to hospitalize a SNF resident for symptomatic refractory volume overload HF or to transition to end-of-life care in the SNF should be based on goals of care and functional and cognitive status
- Intensive educational and behavioral interventions for patients and/or caregivers should accompany implementation of HF guidelines 1.
From the Research
SNF Care Outcomes
The impact of Skilled Nursing Facility (SNF) care on patients can vary depending on several factors, including the patient's condition, the quality of care provided, and the transition from SNF to home or other care settings.
- Studies have shown that SNF care can be beneficial for patients who require further rehabilitation after discharge from an inpatient rehabilitation facility (IRF) 2.
- However, other studies have found that patients with cancer who are discharged to an SNF are less likely to receive subsequent oncologic treatment and have higher mortality rates compared to those discharged home 3.
- Patient risk factors, such as older age, female sex, and comorbidities, can increase the likelihood of discharge to an SNF and are associated with longer lengths of stay, more frequent inpatient medical complications, and greater hospital costs 4.
Transition from SNF to Home
The transition from SNF to home can be a critical period for patients, and the receipt of home healthcare (HHC) services may affect readmission risk.
- One study found that patients who received HHC services after discharge from an SNF had lower 30-day readmission rates and a longer time to readmission compared to those without HHC services 5.
- Another study found that discharge to an SNF was associated with increased death and rehospitalization rates at 30 days and 1 year after discharge, even after adjusting for patient characteristics 6.
Key Findings
Key findings from the studies include:
- SNF care can be beneficial for patients who require further rehabilitation after discharge from an IRF 2.
- Patients with cancer who are discharged to an SNF have poorer outcomes compared to those discharged home 3.
- Patient risk factors can increase the likelihood of discharge to an SNF and are associated with poorer outcomes 4.
- Receipt of HHC services after discharge from an SNF can reduce readmission risk 5.
- Discharge to an SNF is associated with increased death and rehospitalization rates 6.