OBJECTIVES: Centers for Medicare and Medicaid Services (CMS) require patients to be evaluated using setting-specific patient assessment instruments for clinical assessment, payment, and quality assurance. This research examines how wellbeing is assessed in skilled nursing facilities (SNFs) and the role of measurement timing in understanding dimensions of disability, functional limitations, and wellbeing among individuals with alcohol use disorder (AUD). SNFs are central to caregiving and provide short- and long-term skilled nursing care.

METHODS: Data include diagnosis of AUD among residents of SNFs (n= 349,448). We first provide population characteristics with a specific emphasis on gender and dimensions of disability. We then compare different sets of measures of wellbeing and functional limitations given (a) reimbursement-based timing for measuring activities of daily living (ADLs) versus (b) daily measures of ADLs using multivariate regression at multiple time points over the course of treatment.

RESULTS: Descriptive findings confirm that SNF residents with AUD tend to be over age 65 and female residents are underrepresented We find significant differences in ADLs based on treatments, and demographic and clinical characteristics that have differing implications for SNFs’ rehabilitation and wellbeing mandate versus payer-based mandates.

CONCLUSIONS: Measurement timing for functional limitations based on reimbursement purposes, rather than for daily needs evaluation, may support a medical model of disability that emphasizes personal limitations and impairment. The study suggests that a more global understanding of wellbeing that includes social context would benefit health care practitioners, researchers, and patients, especially when considering outcomes among different segments of SNF subpopulations. This suggests that treatment decisions and functional limitations of special populations could benefit from patient-centered measurement, but may be at odds with health care operations. We provide suggestions for adaptive leadership at the SNF, organization, and policy levels