Case mix and outcomes of nursing home patients. The importance of prior nursing home care and admission from home versus hospital.

The authors compared the personal characteristics, measures of functional status/case mix, and discharge outcomes of nursing home patients admitted to skilled nursing facilities (SNFs) in 1984 for the first time (first admissions) to those of patients with a prior history of nursing home care (readmissions). Compared to first admissions, readmitted patients were more disabled and debilitated, significantly less likely to return home, and more likely to be hospitalized. History of a prior nursing home admission is an important indicator of prognosis, service needs, length of stay (LOS) of patients in the nursing home, and their discharge outcomes. Location before admission--home versus hospital--was associated with case-mix descriptors and LOS but was unrelated to discharge outcomes, except for those readmitted from hospitals, who returned home less often and were more likely to die in the SNFs.