Recovery from COVID-19 among older adults in post-acute skilled nursing facilities Post-acute COVID-19 functional recovery

Shi, Sandra; Lo, On-Yee; Newmeyer, Natalie; Bakaev, Innokentiy; Kim, Dae Hyun

Objectives To examine functional outcomes of post-acute care for COVID-19 in skilled nursing facilities (SNFs). Design Retrospective cohort Setting and Participants: 73 community-dwelling adults ≥65 years admitted for post-acute care from two SNFs from March 15th, 2020, to May 30th, 2020. Measure (s): COVID-19 status was determined from chart review. Frailty was measured with a deficit accumulation frailty index, categorized into non-frail, mild frailty, and moderate-to-severe frailty. The primary outcome was community discharge. Secondary outcomes included change in functional status from SNF admission to discharge, based on modified Barthel index (mBI) and continuous functional scale scored by physical (PT) and occupational therapists (OT). Results Among 73 admissions (31 COVID-19 negative, 42 COVID-19 positive), mean (SD) age was 83.5 (8.8) and 42 (57.5%) were female, with mean frailty index of 0.31 (0.01) with no differences by COVID-19 status. The mean length of SNF stay for rehabilitation was 21.2 days (SD 11.1) for COVID-19 negative with 20 (64.5%) patients discharged to community, compared to 23.0 (SD 12.2) and 31 (73.8%) among COVID-19 positive patients. Among those discharged to the community, all groups improved in mBI, PT, and OT score. Those with moderate-to-severe frailty (FI >0.35) had lower mBI scores on discharge (92.0 [6.7] not frail, 81.0 [15.4] mild frailty, 48.6 [20.4] moderate-to-severe frailty; p=0.002), lower PT scores on discharge (54.2 [3.9] non-frail, 51.5 [8.0] mild frailty, 37.1 [9.7] moderate-to-severe frailty; p=0.002), and lower OT score on discharge (52.9 [3.2] non-frail, 45.8 [9.4] mild frailty, 32.4 [7.4] moderate or worse frailty; p=0.001). Conclusions and Implications Older adults admitted to a SNF for post-acute care with COVID-19 had community discharge rates and functional improvement comparable to a COVID-19 negative group. However, those who are frailer at admission tended to have lower function at discharge.