Long term care facilities, encompassing skilled nursing facilities (SNFs), assisted living, and nursing homes, are crucial components of the healthcare system, especially with the growing elderly population. Understanding the prevalent diagnoses within these facilities is vital for healthcare providers, administrators, and families to ensure optimal patient care and resource allocation. This analysis delves into the most common diagnoses in long term care settings, drawing insights from recent healthcare claims data to highlight key trends and inform better healthcare strategies.
Explore dataset
| Rank | ICD-10 code | ICD-10 description | % of claims | Explore dataset |
|---|---|---|---|---|
| 1 | U071 | COVID-19 | 9.33% | Explore |
| 2 | G9341 | Metabolic encephalopathy | 3.30% | Explore |
| 3 | N390 | Urinary tract infection, site not specified | 2.92% | Explore |
| 4 | Z471 | Aftercare following joint replacement surgery | 1.81% | Explore |
| 5 | A419 | Sepsis, unspecified organism | 1.74% | Explore |
| 6 | J189 | Pneumonia, unspecified organism | 1.73% | Explore |
| 7 | G20 | Parkinson’s disease | 1.64% | Explore |
| 8 | Z4789 | Encounter for other orthopedic aftercare | 1.63% | Explore |
| 9 | G9340 | Encephalopathy, unspecified | 1.60% | Explore |
| 10 | J449 | Chronic obstructive pulmonary disease, unspecified | 1.54% | Explore |
| 11 | J9601 | Acute respiratory failure with hypoxia | 1.53% | Explore |
| 12 | I639 | Cerebral infarction, unspecified | 1.49% | Explore |
| 13 | F0390 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 1.07% | Explore |
| 14 | M6259 | Muscle wasting and atrophy, not elsewhere classified, multiple sites | 0.95% | Explore |
| 15 | I69354 | Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side | 0.92% | Explore |
| 16 | J441 | Chronic obstructive pulmonary disease with (acute) exacerbation | 0.91% | Explore |
| 17 | N179 | Acute kidney failure, unspecified | 0.87% | Explore |
| 18 | S72002D | Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing | 0.84% | Explore |
| 19 | S72001D | Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing | 0.84% | Explore |
| 20 | I69351 | Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side | 0.83% | Explore |
| 21 | Z48815 | Encounter for surgical aftercare following surgery on the digestive system | 0.82% | Explore |
| 22 | Z4781 | Encounter for orthopedic aftercare following surgical amputation | 0.77% | Explore |
| 23 | S72142D | Displaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing | 0.76% | Explore |
| 24 | I509 | Heart failure, unspecified | 0.74% | Explore |
| 25 | R278 | Other lack of coordination | 0.73% | Explore |
| 26 | S72141D | Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing | 0.71% | Explore |
| 27 | I4891 | Unspecified atrial fibrillation | 0.68% | Explore |
| 28 | I5033 | Acute on chronic diastolic (congestive) heart failure | 0.59% | Explore |
| 29 | J9621 | Acute and chronic respiratory failure with hypoxia | 0.59% | Explore |
| 30 | M6282 | Rhabdomyolysis | 0.58% | Explore |
| 31 | G309 | Alzheimer’s disease, unspecified | 0.56% | Explore |
| 32 | N186 | End stage renal disease | 0.54% | Explore |
| 33 | Z48812 | Encounter for surgical aftercare following surgery on the circulatory system | 0.53% | Explore |
| 34 | I214 | Non-ST elevation (NSTEMI) myocardial infarction | 0.52% | Explore |
| 35 | F0391 | Unspecified dementia, unspecified severity, with behavioral disturbance | 0.51% | Explore |
| 36 | E119 | Type 2 diabetes mellitus without complications | 0.47% | Explore |
| 37 | L03115 | Cellulitis of right lower limb | 0.46% | Explore |
| 38 | R55 | Syncope and collapse | 0.46% | Explore |
| 39 | L03116 | Cellulitis of left lower limb | 0.45% | Explore |
| 40 | I6930 | Unspecified sequelae of cerebral infarction | 0.42% | Explore |
| 41 | G35 | Multiple sclerosis | 0.42% | Explore |
| 42 | I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | 0.40% | Explore |
| 43 | I5023 | Acute on chronic systolic (congestive) heart failure | 0.38% | Explore |
| 44 | I480 | Paroxysmal atrial fibrillation | 0.37% | Explore |
| 45 | J690 | Pneumonitis due to inhalation of food and vomit | 0.36% | Explore |
| 46 | D649 | Anemia, unspecified | 0.36% | Explore |
| 47 | I69398 | Other sequelae of cerebral infarction | 0.31% | Explore |
| 48 | S065X0D | Traumatic subdural hemorrhage without loss of consciousness, subsequent encounter | 0.31% | Explore |
| 49 | S7291XD | Unspecified fracture of right femur, subsequent encounter for closed fracture with routine healing | 0.30% | Explore |
| 50 | E871 | Hypo-osmolality and hyponatremia | 0.29% | Explore |
Understanding Common Diagnoses in Long Term Care Settings
Analyzing claims data from skilled nursing facilities (SNFs) provides crucial insights into the health challenges faced by residents in long term care. SNFs, which are a significant part of the long term care spectrum, offer short-term rehabilitation and skilled nursing care. Given their focus on elderly and often frail populations, understanding the prevalent diagnoses is paramount for effective healthcare delivery.
According to recent data analysis of medical claims, the leading diagnosis in SNFs is COVID-19, accounting for 9.33% of all claims. Long term care facilities, including SNFs and nursing homes, were particularly vulnerable during the pandemic. The high prevalence of COVID-19 in SNFs underscores the susceptibility of the elderly patient population to infectious diseases, highlighting the ongoing need for robust infection control measures in these settings.
Metabolic encephalopathy ranks as the second most frequent diagnosis, representing 3.30% of SNF claims. This condition, resulting from systemic illnesses such as heart disease, diabetes, and organ failure, is common in older adults requiring long term care. Its prevalence in SNFs emphasizes the complex comorbidities often present in this patient demographic.
Urinary tract infections (UTIs) are the third most common diagnosis, with 2.92% of claims. UTIs are a well-known concern in nursing homes and long term care, representing a significant healthcare-acquired condition. The frequency of UTIs highlights the importance of preventative strategies and prompt diagnosis and treatment protocols within long term care facilities.
Beyond these top three, a range of other diagnoses frequently appear in SNF claims, reflecting the diverse healthcare needs of residents in long term care. These include:
- Respiratory illnesses: Pneumonia and Chronic Obstructive Pulmonary Disease (COPD) are significant concerns, indicating the vulnerability of this population to respiratory infections and chronic lung conditions.
- Neurological disorders: Conditions like dementia and Parkinson’s disease are prevalent, reflecting the neurodegenerative challenges associated with aging and the need for specialized care within long term care settings.
- Orthopedic aftercare: The presence of diagnoses related to joint replacement and orthopedic aftercare highlights the role of SNFs in post-surgical rehabilitation, enabling patients to recover and regain function after orthopedic procedures.
Skilled Nursing Facilities within the Spectrum of Long Term Care
To fully grasp the context of these diagnoses, it’s important to understand what skilled nursing facilities are and how they differ from other types of long term care. A skilled nursing facility (SNF) provides inpatient care, offering both short-term and long-term rehabilitation services. These facilities are characterized by 24-hour licensed medical support for patients needing transitional care after a hospital stay due to illness, injury, or surgery.
SNFs predominantly serve elderly patients and are largely Medicare-certified. Medicare coverage extends to 100 days in an SNF, with patients incurring out-of-pocket expenses for stays beyond this period.
Qualifying for Skilled Nursing Care in Long Term Care Facilities
Medicare sets specific criteria for patients to qualify for skilled nursing care coverage within a SNF. These criteria include:
- Medicare Part A coverage: Patients must have Medicare Part A and available benefit days.
- Qualifying hospital stay: A formal inpatient hospital admission for at least three consecutive days is required.
- Timely SNF admission: Entry into a Medicare-certified SNF must occur within 30 days of hospital discharge and for the same condition treated during hospitalization.
- Medical necessity: A physician must determine the need for daily skilled care, delivered by or supervised by skilled nursing or therapy staff.
Common services provided in SNFs to address these diagnoses and care needs include medication management, assistance with daily living, dietary support, wound care, physical, occupational, and speech therapy, and specialized rehabilitation programs like cardiac and post-stroke rehabilitation.
SNF vs. Assisted Living vs. Nursing Homes: Understanding the Differences in Long Term Care
Distinguishing SNFs from other long term care options like assisted living facilities and nursing homes is crucial. Assisted living facilities offer personal care in a residential setting, catering to individuals needing help with daily activities but less intensive medical intervention. In contrast, skilled nursing facilities are medically focused, providing 24/7 skilled nursing and rehabilitation.
Nursing homes, unlike SNFs which are often for temporary rehabilitation, typically serve as permanent residences for individuals requiring continuous 24/7 care. SNFs are designed for short-term stays focused on recovery and rehabilitation before patients transition to home or another care setting.
Conclusion: Diagnosis Trends Informing Long Term Care Strategies
Understanding the most common diagnoses in long term care facilities, particularly SNFs, is crucial for shaping effective healthcare strategies. The prevalence of COVID-19, metabolic encephalopathy, and UTIs, alongside respiratory and neurological conditions, highlights the complex health needs of this population. By leveraging data-driven insights into diagnosis trends, healthcare providers and long term care administrators can optimize resource allocation, enhance preventative measures, and improve the quality of care for residents in these vital facilities.
