Access to and Choice of High-Quality Skilled Nursing Facility Care for Veterans After Hospitalization: A Cohort Analysis

Abstract Background Use of a high-quality skilled nursing facility (SNF) after hospitalization helps older adults better recuperate and rehabilitate. However, little is known about to what extent older adults are using the highest-quality SNFs in their area. Veterans are a particularly relevant group to study since they can choose from both VA and non-VA SNFs. Objectives To determine access to and use of high-quality SNFs by older Veterans. Research Design Retrospective descriptive cohort study of hospitalized Veterans with subsequent SNF stays from January 1, 2015, to December 31, 2022. Subjects VA enrollees aged 66+ with an acute hospitalization followed by SNF admission within 1 day were included. Measures We defined SNF quality using Medicare and VA SNF star ratings (1 = worst quality, 5 = highest quality) and identified SNFs within 16 miles and 36 miles of the Veteran’s home zip code centroid. Results Of 926,860 Veterans in our sample, more than 92% used non-VA (Medicare-paid) SNFs. Overall, 34.4% of Veterans went to the highest-rated SNF, and 15.4% went to the worst-rated SNF in their area. Nearly two-thirds (64.5%) had at least one SNF in their area with a higher quality rating than the one used, and 43.7% had 5 or more choices that were of higher quality. Overall, 54.9% of Veterans went to a SNF that was rated 4 stars or better. Nearly all (96.9%) had at least 1 SNF rated 4 stars or better in their area, and on average, Veterans had 16.4 SNFs of 4 stars or higher in their area. Conclusions These results suggest significant opportunities to increase use of high-quality SNFs among older adults.