Examining Trends in Nursing Home Placement following Traumatic SCI: Insights from the National SCI Model Systems Database.

Abstract

To examine and compare trends in the discharge rates from inpatient rehabilitation to nursing homes (NHs) in persons with traumatic spinal cord injury (tSCI) from 1970 to 2019. Retrospective analysis of existing data from the national Spinal Cord Injury Model Systems (SCIMS) database in the United States. Persons admitted to a SCIMS center between 1970 and 2019 (N=33,379). Not applicable. Discharge disposition to an NH after inpatient rehabilitation for incident tSCI. The rate of NH discharge increased from 3.6% in the 1970s to 9.5% in 2010-2019, plateauing over the last two decades despite parallel increases in the average age at injury and the shorter durations of rehabilitation length of stay (LOS) over time. Older age, male sex, not being employed or married, complete tetraplegia, bladder dysfunction, ventilator dependence, and longer LOS were factors associated with higher odds of NH discharge. Although the rate of NH discharges has been higher in the past 20 years compared to the 1970s, the rate has stabilized at approximately 9.5% over the past two decades, despite the changing demographics of the tSCI population and shorter rehabilitation LOS. Age, injury severity, functional limitations, and social factors remain key predictors of NH placement, emphasizing the need for individualized discharge planning focused on patient function and independence, and continued investment in community-based supports to promote independence and reduce institutionalization among individuals with SCI.