Evaluation of Outcomes for a Skilled Nursing Facility for Persons Who are Difficult to Place

Article Figures & Data

Table 1

Characteristics of Residents of a Specialized Skilled Nursing Facility According to Pretransfer Facility

	Psychiatric Facility (n = 48)	Correctional Facility (n = 38)	Test Statistic	P
Demographics
Age (years), mean (SD)	61.3 (10.4)	54.6 (13.8)	t = −2.56	0.01
Male	42 (87.5)	35 (92.1)	χ² = 0.48	0.49
Race			χ² = 1.23	0.54
White/nonhispanic	27 (56.2)	17 (44.7)
Black	13 (27.1)	14 (36.8)
Hispanic	8 (16.7)	7 (18.4)
Health services use/antipsychotics
Emergency room visit^*	1 (2.1)	11 (29.0)	χ² = 12.75	<0.001
Acute inpatient hospitalization^*	11 (22.9)	20 (56.2)	χ² = 8.12	0.004
Antipsychotic prescription^{^†}	32 (71.1)	5 (13.5)	χ² = 31.87	<0.001
MDS admission data
Cognition score, mean (SD), median^{^‡}	9.9 (4.0), 10.5	13.6 (1.9), 15.0	Z = 4.64	<0.001
Depression symptom severity score, mean (SD), median^{^§}	3.6 (3.5), 3.0	3.7 (4.0), 2.5	Z = −0.04	0.96
Behavioral symptoms^{^¶}	7 (14.9)	1 (2.6)	χ² = 3.60	0.07

Data are number of patients (% of subgroup), unless otherwise indicated.
↵* Refers to the 12 months before admission to the SNF.
↵† Five residents were missing antipsychotic prescription data at baseline.
↵‡ Assessed via the Brief Interview for Mental Status (BIMS).¹⁸ Scores range from 0 to 15; higher scores indicate better cognition, with scores of <7 indicating severe impairment. A total of 77 residents completed the BIMS at admission.
↵§ Assessed via the 9-item Physician Health Questionnaire (PHQ-9).¹⁹ Scores range from 0 to 27, and higher scores indicate greater severity.
↵¶ Assessed as the overall presence of physical (e.g., hitting, kicking, grabbing), verbal (e.g., screaming, cursing), and other (scratching self, throwing food or bodily waste) behavioral symptoms.

Table 2a

Change in Health Services Use Among Residents of a Specialized SNF

Health Services Use	12 months Before Admission, n (%)	12-months After Admission, n (%)	Test Statistic	P
Acute inpatient hospitalization	31 (36.5)	9 (10.6)	χ² = 15.82	<0.001
Emergency room visit	12 (14.1)	11 (12.9)	χ² = 0.05	0.82

Table 2b

Quality-of-Life Indicators Among Residents of a Specialized SNF

Quality-of-Life Indicators	Admission Mean (SD)	First quarter Mean (SD)	Second quarter Mean (SD)	Test Statistic	P
Cognition score^*	11.7 (3.6)	11.4 (4.1)	10.7 (4.1)	F = 0.08	0.93
Depression symptom severity score^{^†}	3.6 (3.7)	3.1 (3.7)	2.7 (3.5)	F = 1.18	0.31

↵* Assessed via the Brief Interview for Mental Status (BIMS)¹⁸ in the MDS 3.0. Scores range from 0 to 15; higher scores indicate better cognition, with scores of <7, indicating severe impairment.
↵† Assessed via the nine-item Physician Health Questionnaire (PHQ-9) in the MDS 3.0¹⁹; scores range from 0 to 27: and higher scores indicate greater severity.

Table 3

Changes in the Number of Antipsychotic Medication Prescriptions for Specialized SNF Residents Between Admission and Six Months

Change in Number of Medications	n (%)
Antipsychotic prescription at admission (n = 33)^*
Decreased from ≥1 antipsychotic prescription to 0	4 (12.1)
Decreased from ≥2 antipsychotics prescriptions to 1	5 (15.2)
Increased from 1 antipsychotic prescription to ≥2	3 (9.1)
No antipsychotic prescription at admission (n = 40)
Increased from 0 antipsychotic prescriptions to ≥1	4 (10.0)

↵* Antipsychotic medications included aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone.