In 2015, about one out of five hospitalized Medicare beneficiaries was discharged to a skilled nursing facility (SNF). Although most beneficiaries admitted for SNF care can expect to return home within a few days or weeks, some older adults who enter a nursing home following a hospitalization are at risk of a long-term nursing home stay—especially those who have dementia, who are very frail, or who lack a family caregiver and other community supports. Since some of these long stays may be preventable, the Long-Term Services and Supports State Scorecard contains the following measure: percentage of new (posthospital) nursing home stays lasting 100 days or more. Nationwide, the percentage of these long stays dropped from 20.6 percent in 2009 to 18.7 percent in 2012, reflecting the long-term decline in the use of nursing homes among older adults. However, state performance varies widely, with fewer than 15 percent of new nursing home stays lasting 100 days or more in highly ranked states including Maine, Oregon, and Minnesota, compared with 25 percent or more in the three lowest-ranked states. This Promising Practices Paper describes strategies used in four highly ranked or significantly improved states (Connecticut, Maine, Minnesota, and Oregon) that may reduce the risk of long-term nursing home care after a hospitalization. The paper also includes a toolkit of resources that can help others learn more and potentially replicate these practices, as well as contact information for experts from these four states.
