November 17, 2025
McKnight's Long-Term Care News
Hospitals are referring a larger share of stroke patients to inpatient rehabilitation facilities, which typically favor home health as the provider of any additional step-down care, a recent study finds.
More than one-third (35%) of patients received no post-acute care after being hospitalized for stroke. But 28% were sent to an IRF within 10 days, followed by 24% admitted directly to a SNF after hospitalization, and another 13% referred directly to home care.
The analysis of Medicare Part A claims from nearly three years ending in September 2019 additionally found that 14.6% of SNF and IRF patients also were referred for home care later in their recovery.
Researchers said the new data could inform new guidance regarding post-stroke care transitions, noting wide variability in post-acute care access by geography and patient demographics.
“Our findings could help develop strategies to improve the continuity of care in patients with stroke with the goal to improve poststroke rehabilitation care and services,” they wrote in the November issue of JAMDA. “Current stroke care guidelines do not emphasize the comprehensive nature of the continuity and transition of care. In the absence of clear guidelines on the transition of care, there is a probability of patients who may underuse or overuse the services, and nonclinical factors might be associated with the decision of post-acute services use.”
The team, led by Amol Karmarkar of the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University, noted the important role of post-acute care across the phases of stroke recovery.
Within 90 days of a stroke, patients experience a high risk of developing medical complications, which can adversely impact recovery, they wrote. But some 80% of patients in the study period received no secondary post-acute care after their first move, the study showed.
“Patients may be deemed appropriate to continue requiring additional care services and rehabilitation following discharge from the first institutional post-acute care, either in IRF or SNF,” said the authors, who identified and measured the prevalence of seven post-acute referral patterns and related trajectories.
Across the entire nation, only one small area in the Mountain West region saw IRF providers routinely send stroke survivors on to nursing homes for additional care. On the East and West coasts, most patients went from home health care to no services or from SNF to no further services. Post-acute care across more than one setting was generally lower in rural regions.
“This finding may be related to differences in state policies and post-acute care market availability,” the researchers wrote. “Future studies are recommended to study the impact of these seven patterns on patient short-term and long-term outcomes to better address the appropriate level of care and the need for multiple post-acute care transitions.”