Cognitive Status of Older Adults on Admission to a Skilled Nursing Facility According to a Hospital Discharge Diagnosis of Dementia

Objective Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries. Design Retrospective cohort design. Setting SNFs in the United States. Participants Medicare-fee-for-service beneficiaries newly admitted to an SNF within 3 days of discharge from an acute hospital during 2013–2014 (n = 1,885,015). Measurements Beneficiaries with a discharge diagnosis of dementia were identified using ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file. Cognitive status at SNF admission was classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired according to the Cognitive Function Scale using items in the Minimum Data Set 3.0. Results For beneficiaries with a discharge diagnosis of dementia (n = 252,970), 17.9% were classified as cognitively intact, 25.8% were mildly impaired, and 56.3% were moderately or severely impaired on SNF admission. Approximately 65% of beneficiaries without a hospital diagnosis of dementia were cognitively intact on admission to an SNF, whereas 13.1% were classified as moderately or severely impaired. Conclusion Medicare beneficiaries with a hospital diagnosis of dementia are often classified as cognitively intact or mildly impaired on admission to an SNF. These findings provide evidence that a hospital diagnosis of dementia might not always reflect cognitive status on admission to an SNF.