Hospitalization for pneumonia comes at a steep cost for nursing home residents, a new study finds. Advance care planning and rehabilitation efforts are key to ensuring successful post-acute care, investigators say.

The researchers followed Medicare enrollees, pulling data from multiple Minimum Data Set assessments. They found that among nearly 250,000 U.S. nursing home residents admitted to a hospital for pneumonia between 2013 and 2014, fully 90% experienced severe disability or death following their stay. Strikingly, 53% of residents with no functional limitations prior to hospital admission developed severe decline within 60 days after discharge, reported Joan M. Teno, M.D., of Oregon Health and Science University, Portland.

In the COVID-19 era, the researchers are urging nursing homes to plan for an influx of discharged residents with severe functional limitations that may require a higher level of care.

“It is crucial to discuss possible outcomes of seemingly routine care with patients and their families well in advance so that appropriate decisions can be made in times of acute illness,” they wrote. “Additionally, during this time, when admitting new residents or readmitting former residents, providers should discuss likely outcomes following hospitalization for pneumonia to inform advance care planning,” they concluded.

Full findings were published in JAMDA.