Shorter SNF Stays Could Mean More Room for Home-Based Care

Patients recovering at a skilled nursing facility (SNF) can often be discharged home much sooner than they typically are without resulting in a negative health outcome, new research suggests.

And if that were to happen more frequently, it could potentially save the U.S. health care system millions of dollars in post-acute care spending while setting up greater opportunities for home-based care providers down the road.

The new findings on shortening SNF stays were published Monday in the journal Health Affairs. To explore the topic, researchers looked at fee-for-service Medicare claims and enrollment data from SNF benefit periods covered by Part A from 2007 to 2015.


Overall, SNFs make up almost half of all Medicare post-acute spending. But time spent in SNF settings can be unnecessarily long, meaning much of that spending can likely be slashed or diverted elsewhere.

“Discharges prompted by cost-sharing shifted patients almost entirely to home, including a substantial proportion discharged to home without home health care and thus without ostensible need for continued rehabilitative therapy or skilled nursing care,” the researchers wrote in Health Affairs.

Still, transferring care from a SNF into the home must be done in a way that ensures a patient won’t experience negative impacts to their health, they noted.


In the cases where SNF stays had reductions of more than a week in length, researchers found that there was no increase in hospitalizations, deaths or fall-related injuries.

In other words, there is no evidence that earlier discharge from a SNF to the home setting significantly risked patient safety.

“I think what our results suggest is that, by and large, these are discharges that are late, so to speak,” Brian E. McGarry, one of the study’s authors and an assistant professor at the University of Rochester, told Home Health Care News. “These seem to be disproportionately healthy patients who probably could have gone home a little bit earlier in the SNF stay.”

Researchers also found that about 30% of SNF patients were discharged to their homes without home health care.

“The way the current Medicare benefit is designed right now creates this incentive to sort of consume the piece that could be delivered in the home and just provide that sort of continued rehab care in the SNF,” McGarry said.

A key takeaway from the study is that the current Medicare policy is driving arbitrary non-clinical decision-making around when to discharge nursing home patients, according to McGarry.

“This kind of lends support to the idea that there’s a fair amount of waste in current post-acute SNFs use, and that it’s potentially a place to try and improve efficiency,” he said.

One avenue for this improvement is through home-based care services, which allow patients to leave SNFs while still receiving support.

“Patients may not need the very intense kind of 24-hour supervision that really differentiates SNFs from home-based rehab services,” McGarry said. “Given that patients can go home earlier in the SNF stays — it really becomes a matter of what’s the best way to deliver continued rehabilitation services at home.”

On the flip side, in cases where a patient may still benefit from intensive care, a SNF-at-home program may be the answer.

“The study’s findings … support the notion of continuing to innovate in the area of home care and finding ways to deliver rehabilitative services in patients’ homes, which I think, generally speaking, patients prefer,” McGarry said.

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