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

Peter A. Selwyn, Joseph L. Goulet, Susan Molde, Janet Constantino, Kristopher P. Fennie, Patricia Wetherill, Denise M. Gaughan, Helena Brett-Smith, Catherine Kennedy

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective. To describe the characteristics and outcomes of the first 3 years of admissions to a dedicated skilled nursing facility for people with acquired immunodeficiency syndrome (AIDS). Methods. Systematic chart review of consecutive admissions to a 30-bed, AIDS-designated long-term care facility in New Haven, Connecticut, from October 1995 through December 1998. Results. The facility has remained filled to 90% or more of its bed capacity since opening. Of 180 patients (representing 222 admissions), 69% were male; 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 treatment, and (3) terminal care. On admission, the median Karnofsky score was 40, and median CD4+ cell count was 24/mm3; 48% were diagnosed with serious neurologic disease, 44% with psychiatric illness; patients were receiving a median of 11 medications on admission. Of 202 completed admissions, 44% of patients died, 48% were discharged to the community, 8% were discharged to a hospital. Median length of stay was 59 days (range 1 to 1,353). Early (≤6 months) mortality was predicted by lower admission CD4+ count, impairments in activities of daily living, and the absence of a psychiatric history; long-term stay (>6 months) was predicted by total number of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significantly decreased mortality rates and increased prevalence of psychiatric illness 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 convalescence, 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 antiretroviral therapies and/or have significant neuropsychiatric comorbidities. This level of care may be increasingly important not only in reducing lengths of stay in the hospital, but also as a bridge to community-based residential options in the emerging chronic disease phase of the AIDS epidemic.

Original languageEnglish (US)
Pages (from-to)187-203
Number of pages17
JournalJournal of Urban Health
Volume77
Issue number2
StatePublished - Jun 2000

Fingerprint

Skilled Nursing Facilities
Long-Term Care
Acquired Immunodeficiency Syndrome
nursing
Chronic Disease
terminal care
HIV
Disease
Psychiatry
Terminal Care
CD4 Lymphocyte Count
Nervous System Diseases
Length of Stay
medication
illness
mortality
Mortality
Patient Admission
comorbidity
Acute Disease

Keywords

  • AIDS
  • End-of-Life Care
  • Health Services
  • Long-Term Care
  • Palliative Care
  • Skilled Nursing Facilities

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Selwyn, P. A., Goulet, J. L., Molde, S., Constantino, J., Fennie, K. P., Wetherill, P., ... Kennedy, C. (2000). HIV as a chronic disease: Implications for long-term care at an AIDS- dedicated skilled nursing facility. Journal of Urban Health, 77(2), 187-203.

HIV as a chronic disease : Implications for long-term care at an AIDS- dedicated skilled nursing facility. / Selwyn, Peter A.; Goulet, Joseph L.; Molde, Susan; Constantino, Janet; Fennie, Kristopher P.; Wetherill, Patricia; Gaughan, Denise M.; Brett-Smith, Helena; Kennedy, Catherine.

In: Journal of Urban Health, Vol. 77, No. 2, 06.2000, p. 187-203.

Research output: Contribution to journalArticle

Selwyn, PA, Goulet, JL, Molde, S, Constantino, J, Fennie, KP, Wetherill, P, Gaughan, DM, Brett-Smith, H & Kennedy, C 2000, 'HIV as a chronic disease: Implications for long-term care at an AIDS- dedicated skilled nursing facility', Journal of Urban Health, vol. 77, no. 2, pp. 187-203.
Selwyn PA, Goulet JL, Molde S, Constantino J, Fennie KP, Wetherill P et al. HIV as a chronic disease: Implications for long-term care at an AIDS- dedicated skilled nursing facility. Journal of Urban Health. 2000 Jun;77(2):187-203.
Selwyn, Peter A. ; Goulet, Joseph L. ; Molde, Susan ; Constantino, Janet ; Fennie, Kristopher P. ; Wetherill, Patricia ; Gaughan, Denise M. ; Brett-Smith, Helena ; Kennedy, Catherine. / HIV as a chronic disease : Implications for long-term care at an AIDS- dedicated skilled nursing facility. In: Journal of Urban Health. 2000 ; Vol. 77, No. 2. pp. 187-203.
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