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Objectives: Physical and cognitive conditions of patients discharged to skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and home with home health agencies (HHAs) following total joint arthroplasty (TJA) have not been evaluated. The purpose of this study is to examine the physical and cognitive function trends of Medicare beneficiaries discharged to SNFs, HHAs, and IRFs following TJA from 2013 to 2018., Design: Observational study using Medicare enrollment, claims, and assessment data from 2013-2018., Setting and Participants: 1,278,939 Medicare beneficiaries discharged to SNFs, HHAs, or IRFs for post-acute care following TJA from 2013 to 2018., Methods: Medicare data were used to examine the association between the endpoints of interest [discharge destination (SNF, HHA, or IRF) and the physical (measured using activities of daily living) and cognitive (measured using a range of setting-specific metrics) status of patients in each setting] and the year of TJA (2013-2018) by estimating multivariable models that controlled for patient- and hospital-level covariates., Results: Multivariable analysis of 1,278,939 TJAs revealed that SNF discharge decreased [44.15% (2013)-21.57% (2018), P < .001], HHA increased (46.72%-72.47%, P < .001), and IRF decreased (9.13%-5.69%, P < .001). For SNF, the mean physical function scores [14.61 (2013)-14.23 (2018), P < .001] and cognitive impairment (13.25%-12.33%, P = .01) decreased, indicating less dependence. Physical function scores (3.09-3.94, P < .001) and cognitive impairment (13.95%-16.52%, P < .001) increased for HHA patients, indicating greater dependence. For IRF, motor functional independence measure decreased (38.81-37.78, P < .001) and cognitive dependence increased (39.08%-46.36%, P < .001), indicating greater dependence., Conclusions and Implications: From 2013 to 2018, patients were increasingly discharged to HHA. Although SNF patients were less dependent over time, HHA and IRF patients were physically and cognitively more dependent. Each setting is likely to benefit from policy and fiscal supports that help them manage changes in the volume and clinical intensity of patients requiring their services., Competing Interests: Disclosure NA does not report any conflicts of interest. MY reports receiving a research grant from the Department of Defense. CPT reports receiving speaker honoraria from the National Institutes of Health and Boston University; reviewer honoraria from the National Institutes of Health and the Veterans Affairs; and serves as the Disparities Section Editor for Current Osteoporosis Reports, and Anesthesia and Analgesia. BFR receives research funding outside this work from Johnson & Johnson and the National Institutes of Health; serves as an editorial board member of Clinical Orthopaedics and Related Research, HSS Journal, The Knee, and Arthroplasty Today; and serves as a committee member for the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)