Skilled Nursing Facility Population Characteristics and Length of Stay: A Prospective Cohort Study

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OBJECTIVES: Skilled nursing facilities (SNFs) offer short-term, subacute care following injury or hospitalization, with Medicare fully covering stays ≤20 days. As the US population ages, SNF demand is increasing, yet this population remains poorly characterized. Prolonged stays increase pathogen exposure, with shared spaces and visitors potentially elevating viral transmission. We estimated the prevalence of self-reported respiratory symptoms, shared space use, and visitor frequency among SNF residents and their associations with length of stay (LOS). DESIGN: Prospective cohort study. SETTINGS AND PARTICIPANTS: A total of 313 SNF residents enrolled in Tracking Acute Respiratory Illness in Older Adults (TARI) (April 2021-May 2023). METHODS: Participants were enrolled after SNF admission and followed every 3 days for up to 5 visits. Demographics, health behaviors, and medical history were collected, with respiratory symptoms and facility use assessed at each visit. We fitted lognormal survival models to evaluate associations between patient characteristics and LOS. RESULTS: Participants averaged 77 years of age and 63.3% were women; 23.2% reported respiratory symptoms at entry, but prevalence declined over time. Other than rehabilitation services, few used shared spaces; 84% had visitors. Average LOS was 21.82 days. Dependence for activities of daily living [hazard ratio (HR) 1.63; 95% CI 1.42-1.86] and having a vascular access and/or surgical drain (HR 1.37; 95% CI 1.09-1.73) were associated with significantly longer LOS, whereas older age and heart disease predicted shorter stays. CONCLUSIONS AND IMPLICATIONS: We identify LOS predictors to aid in discharge planning and introduce the "healthy elder effect" hypothesis into literature.

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