Skilled Nursing Facility-to-Home Trajectories for Older Adults With Mental Illness or Dementia

•What is the primary question addressed by this study?This study's objectives were to examine how mental illness (MI) and Alzheimer's disease and related dementias (ADRD) were associated with whether skilled nursing facility (SNF) residents returned to and remained in the community and if receipt of home health services was associated with post-SNF home time.•What is the main finding of this study?Older adults with MI or ADRD admitted to SNFs were less likely to have a community discharge and, if discharged, spent less time in the community; these associations were mediated in large part by depressive symptoms, aggressive behaviors, and daily functioning. Receipt of post-SNF home health services was associated with increased home time among those with MI or ADRD.•What is the meaning of the finding?Care transition interventions targeting depressive symptoms, aggressive behaviors, and functioning and improving linkage with home health services may help decrease differences in post-acute care trajectories between those with and without MI and ADRD. To examine how mental illness (MI) and Alzheimer's disease and related dementias (ADRD) were associated with whether skilled nursing facility (SNF) residents returned to and remained in the community and if receipt of home health services was associated with post-SNF home time. Retrospective cohort study based on secondary data analyses. New York State Medicare beneficiaries who were admitted to an SNF in 2014. Total of 46,137 older adults admitted to SNFs and 25,357 discharged from SNFs to home. We used Medicare claims and assessment databases to derive our outcomes (discharge to the community and home time [i.e., days alive in the community]), determine MI/ADRD status, and obtain socio-demographic and clinical characteristics. Among SNF admissions, 22.9% had MI, 22.6% had ADRD, and 59.0% were discharged to the community. In analyses adjusting for socio-demographic and clinical characteristics, MI and ADRD were associated with decreased odds of community discharge and less home time during 90-days of follow-up. However, when we included depressive symptoms, aggressive behaviors, and daily functioning in the analyses, these associations were attenuated. Receipt of post-SNF home health services was associated with increased home time among those with MI or ADRD. Newly admitted SNF residents with MI or ADRD were less likely to be discharged and, if discharged, spent less time in the community. Interventions targeting