Evaluation of Outcomes for a Skilled Nursing Facility for Persons Who are Difficult to Place

Individuals with serious mental illness, prisoners, and ex-offenders needing skilled nursing facility (SNF)-level care are difficult to place in traditional SNFs. SNFs accepting these historically marginalized individuals may offer them a more appropriate level of care. We compared health services use (emergency room (ER) visits, acute hospitalizations), total number of antipsychotic medications prescribed, and quality-of-life indicators (depressive symptoms, cognition, resident behaviors), before and after admission, among 86 individuals admitted to a Connecticut SNF for persons difficult to place. Residents were racially diverse, primarily male (89%), and 58.4 (+/- 12.5) years of age; 56 percent were transferred from state psychiatric facilities. Twelve-month hospitalization rates decreased from 36.5 to 10.6 percent, 27 percent of those taking an antipsychotic medication at admission experienced a reduction in total number of antipsychotics prescribed by six months, and 13 residents transitioned into the community. Quality-of-life indicators did not change between admission and first quarterly assessment. A SNF for persons difficult to place may help prevent hospitalizations, optimize antipsychotic medication use, and serve as an intermediate step into the community. These findings may inform development of an evidence-based model for establishing SNFs in other states for persons who are difficult to place.