Nursing home rehabilitation after acute rehabilitation: Predictors and outcomes

Objective: To determine the predictive factors and functional outcomes of patients who were discharged from an acute rehabilitation unit to a nursing home care unit (NHCU) at a Veterans Affairs (VA) hospital. Design: Cohort descriptive study. Setting: An academically affiliated urban VA Medical Center. Patients: All patients (n = 81, median age 68 years) admitted to a VA rehabilitation unit over a 1-year period. Outcome Measures: Discharge locations, predictors for NHCU transfer, and functional status as determined by Functional Independence Measure (FIM) scores. Results: Patients discharged to the NHCU (17%) were compared with those discharged to the community (80%). Multiple logistic regression analysis showed that acute rehabilitation length of stay (LOS), admission, and discharge FIM scores were the only independent variables that predicted discharge to the VA NHCU. Although overall FIM gains in both groups during acute rehabilitation were similar, the NHCU group had significantly lower admission FIM scores and lower LOS efficiency because of longer acute rehabilitation LOS. Postacute NHCU rehabilitation resulted in significant gains in FIM scores at a slower rate. Sixty-four percent of these nursing home patients eventually returned to the community. Conclusion: Nursing home rehabilitation can result in favorable functional and community outcomes for selected patients. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.