Background: Identifying patients who need Nursing Home (NH) care following a hospital admission is important.

Objective: To identify the factors that predispose to an NH discharge.

Design: Prospective observational study with blinded end-point evaluation.

Setting: A non-acute geriatric hospital.

Subjects: Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness.

Main outcome measures: Discharge to an NH or home.

Results: Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0–2 factors, 25.8% for 3–4 factors and 81.8% for 5–6 factors (p < 0.0001).

Conclusion: These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.