The SNF-at-Home program is gaining attention as a viable solution to address the lack of beds in nursing homes and rehabilitation facilities, with the aim of reducing bottlenecks in hospitals.
Signs of the success of the SNF-AT-Home program – Although mostly anecdotes at this point, two simultaneous studies at UMass Chan Medical School and Mass General Brigham reveal the results in several SNF-AT-Home programs.
Dr. Apurvi Soni, an assistant professor of medicine who leads the research study at UMass Chan Chan Medical School, told Skilled Nursing News that they were unable to share data on readmission rates measuring success as the trial is still ongoing, but feedback from registered patients who have been discharged from home on behalf of the nursing facility is encouraging.
“(o)UR patients are very uplifted to be randomized to the home arm,” Soni said.
In addition to measuring clinical success, he said, one of the goals of the UMASS study is to investigate the costs of SNF home care compared to nursing home care.
The SNF-at-Home program offers patients the ability to recover from home with the help of physical therapists, home health aides and remote surveillance devices. And this approach provides an alternative to patients who no longer need hospital care but are not ready for independent.
Aside from the Massachusetts test sites, such programs are currently underway in several regions, including New York, Pennsylvania and Wisconsin, according to an article in KFF Health News.
Home rehabilitation is especially useful in rural areas where access to nursing homes is problematic due to closures.
In Wisconsin, for example, the only option is the SNF-at-Home program at the Marshfield Clinic Health System, which has been operating for six years, Swetha Gudibanda, medical director of the Hospital-at-Home program, told KFF News.
“This will be the future of medicine,” Gudivanda said.
These programs also show fewer adverse patient outcomes, such as bed pain and infections.
According to 2024 internal company data shared with KFF, a program run by Nashville-based Contessa Health found that one patient was infected while at home, not just 0.3% of patients who developed bed pain. The program relies on family caregivers and partners on five health systems, including Mount Sinai and the Allegheny Health Network, according to the KFF article.
However, despite its success, the concept of SNF-at-home faces challenges due to the lack of federal standards, clarity of services offered, a refund model, and the need for careful patient selection.
Additionally, it is difficult to tell how widespread these programs are in Medicare fees in the US, and most insurers do not cover such care at home. Therefore, the program is limited to your own insurance company or hospital systems using “bundled payments.” This will allow providers to receive set fees to manage care, such as Medicare Advantage Plans.
“Truest Form's SNF-AT-Home doesn't exist very often in non-specific situations or value-based programs,” Soni issued a statement in an email to SNN. “That means there are several rehabilitation programs that try to provide enhanced home health services, but few are true alternatives to SNF,” he said.
However, the need to replace hospital care and nursing home care is enormous. According to a 2022 study by the American Hospital Association, described in KFF's work, staffing shortages in post-acute facilities nationwide increased the length of stay for patients requiring skilled nursing by 24% over three years.
Additionally, one in five Medicare patients will be admitted to a certain level of rehabilitation facility after the inpatient stay.
“There is already a crisis because there is no sufficiently skilled nursing facility,” Soni said earlier. “From a health system perspective, being able to have an expansion program that can drain patients is extremely important.”
The results of patients admitted to skilled nursing facilities were not as successful as they should have, with one in four of those patients returning to the hospital within 30 days, Soni said.
And moving to home for rehabilitation seems to speed up recovery, Dr. Wendy Mitchell, medical director of UMass Chan clinical trials, highlights a KFF article. This is because treatment is tailored to your home environment and allows patients to navigate the exact stairs and bathrooms they will ultimately use themselves.
The Pop General Brigham Study uses technology to reduce reliance on skilled staff on home visits from nurses and doctors, and medical assistants remotely monitor patients using portable ultrasound, x-ray and blood test equipment.
The randomized clinical trial of UMass Chan Medical School, which researchers first began enrolling patients last summer, is supported by a $6.5 million state grant. The aim is to enroll 650 patients eligible for inpatient level skilled nursing after acute hospitalization.
The Massachusetts-based study also offers services such as overnight aides and remote access to live support. However, selecting the right patient is important. This is important as demonstrated when patients with mild dementia are readmitted after suffering from unfamiliar caregivers.
In test cases for Mass General's SNF-AT-Home program, after returning home, patients may receive guidance on tracking vital signs using remote health devices, and nurses regularly visit blood samples and tests. While physical and occupational therapists are on hand to provide treatment every day, home health aides help several hours each day and provide daily meals.
The patients featured in the KFF article reported that they used pedestrians, navigating with help with stairs, and after staying home for a week, they moved to a reduced frequency of home therapy.
