Objectives
To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home (NH) receiving skilled nursing facility (SNF) services.
Design
Observational study.
Participants
Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during a SNF stay.
Measurements
Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community < 30 days), successful community discharge (in the community ≥30 days), death, and institutionalization.
Results
Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to a SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained less than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care.
Conclusion
SNF care aims to maximize the short-stay patient’s independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient’s plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed healthcare decisions.