HIV as a chronic disease: Implications for long-term care at an aids-dedicated skilled nursing facility

Objective. To describe the characteristics and outcomes of the first 3 year s of admissions to a dedicated skilled nursing facility for people with acq uired immunodeficiency syndrome (AIDS). Methods. Systematic chart review of consecutive admissions to a 30-bed, AID S-designated long-term care facility in New Haven, Connecticut, from Octobe r 1995 through December 1998. Results. The facility has remained filled to 90% or more of its bed capacit y since opening. Of 180 patients (representing 222 admissions), 69% were ma le; mean age was 41 years; 57% were injection drug users; 71% were admitted directly from a hospital. Leading reasons for admission were (1) the need for 24-hour nursing/medical supervision, (2) completion of acute medical tr eatment, and (3) terminal care. On admission, the median Karnofsky score wa s 40, and median CD4+ cell count was 24/mm(3); 48% were diagnosed with seri ous neurologic disease, 44% with psychiatric illness; patients were receivi ng a median of 11 medications on admission. Of 202 completed admissions, 44 % of patients died, 48% were discharged to the community, 8% were discharge d to a hospital. Median length of was 59 days (range 1 to 1,353). Early (le ss than or equal to 6 months) mortality was predicted by lower admission CD 4+ count, impairments in activities of daily living, and the absence of a p sychiatric history; long-term stay (>6 months) was predicted by total numbe r of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significan tly decreased mortality rates and increased prevalence of psychiatric illne ss between the two periods (P < .01). Conclusions. A dedicated skilled nursing facility for people with AIDS can fill an important service need for patients with advanced disease, acute co nvalescence, long-term care, and terminal care. The need for long-term care may continue to grow for patients who do not respond fully to current anti retroviral therapies and/or hare significant neuropsychiatric comorbidities . This level of care may be increasingly important not only in reducing len gths of stay in the hospital, but also as a bridge to community-based resid ential options in the emerging chronic disease phase of the AIDS epidemic.