Skilled Nursing Facility Care At Home
Purpose
We will perform a parallel-group multicenter patient-level randomized controlled evaluation of skilled nursing facility care at home. Patients typically referred to a skilled nursing facility following hospitalization will be eligible for enrollment. Instead of admission to a skilled nursing facility, participants will receive care from a technology-enabled team in their own homes or will be allocated to receive care in a traditional skilled nursing facility setting.
Conditions
- Skilled Nursing Facility
- Rehabilitation
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- >=18 years old - Requires SNF PAC care following hospitalization, as determined by the inpatient team (requires documented rehabilitative therapy recommendation) - Community-dwelling before hospitalization - Likely to return to community-dwelling status following short-term rehabilitation as determined by RAH liaison - Lives within 10 miles of any study site hospital (or per specified catchment) - Surgical trauma and elective patients (weight bearing as tolerated and transfer with no more than one-person assist) - Neurology patients - Stroke (needs acute rehabilitation, but insurance will not cover, so bound for SNF. Does not meet acute rehabilitation criteria and does not need long-term placement)
Exclusion Criteria
- Environmental - Undomiciled - No working heat (October-April), no working air conditioning if forecast > 80°F, or no running water - In police custody - Resides in a facility that does not allow advanced on-site care - Domestic violence screen positive - Weapons that cannot be appropriately secured - Difficulty accessing the bathroom (unless there is space for a bedside commode where the patient sleeps or if the patient is entirely dependent on toileting) - Home has insufficient accessible space to sleep, eat, and perform rehabilitative therapy - Home lacks sufficient kitchen facilities to either cook or heat meals - Patient, or patient's family caregiver, unable to communicate via telephone - Patient, or patient's family caregiver, lacks consistent access to a telephone - Clinical - Requires more than one assist (unless the family can provide additional 24/7 assistance) - Requires care of new ostomy or teaching ostomy care - Requires frequent suctioning, tracheostomy, and ventilator needs - Requires total parenteral nutrition - Requires nasogastric tube feeds - Requires durable medical equipment not already in place at home and excluded below - Requires daily subcutaneous injection unless patient or family caregiver is teachable and able to administer daily - Acute delirium noted by RAH liaison requiring more than one caregiver - Active psychiatric diagnosis without an adequate treatment plan - On methadone requiring daily pickup of medication - Requires administration of intravenous controlled substances - Requires administration of specialty medications not already in place at home - Requires transfusion of blood products - Requires three times weekly or more transfers back and forth to obtain specialty medical care - Requires hemodialysis - Orthopedic trauma and elective patients - Traumatic brain injury - Wound or appliance care that requires daily nursing care - For spine trauma: neurologic deficits requiring more than one assist - Neurology patients - PRESS score (for ischemic stroke; use PRESS app): no return to pre-stroke diet > 50% - FUNC score (for primary intracerebral hemorrhage only): <75% probability of functional independence at 90 days - ASTRAL score (for ischemic stroke only and patients with pre-stroke independence [Modified Rankin Scale 0-2]): <75% probability of a 90-day poor functional outcome (Modified Rankin Scale result of 3-6) - RAH census is full
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Other
- Masking
- Double (Investigator, Outcomes Assessor)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
No Intervention Usual skilled nursing facility care |
Control subjects will receive care at a skilled nursing facility as per usual. |
|
|
Active Comparator Rehab at home |
Intervention subjects will receive care in their home from a specialized care team. |
|
Recruiting Locations
Boston Medical Center
Boston, Massachusetts 02118
Boston, Massachusetts 02118
More Details
- Status
- Recruiting
- Sponsor
- Brigham and Women's Hospital