Date Presented 04/03/2025
Evaluates the feasibility of a Skilled Nursing Facility at Home program by measuring process, functional, and financial outcomes of 100 patients recovering from orthopedic surgery and stroke. This program highlights the contributions and value of OT.
Primary Author and Speaker: Scott George Rushanan
PURPOSE: To assess the feasibility of a lower cost and occupational based alternative to facility care, through measuring process, clinical, and financial outcomes for 100 patients recovering from orthopedic surgery and stroke in a skilled nursing facility (SNF) at home program.
DESIGN: Retrospective observational analysis of a SNF at Home Program consisting of: 1) Core offerings: a. pre discharge/pre surgery home assessment; b. admission to home health on day of discharge; c. daily occupational therapy (OT) and physical therapy (PT) for 7 days; d. nursing; e. remote patient monitoring; f. social work; g. home health aide. 2) Supplemental offerings: a. meal delivery service; b. personal care; c. community health worker; d. medication delivery. Patients enrolled in SNF at home based on ability to perform ADL and functional transfers with assistance of one person, supportive home environment, clinical judgement of discharging providers, and a desire to return home versus admission to a facility for post-acute care. Descriptive and comparative statistics to be used to characterize the sample.
METHOD: Clinical Outcomes: Timed up and Go (TUG), Outcome and Assessment Information Set (OASIS), 30-day rehospitalization, and ED use. Process Outcomes: Lag time to home health (HH) admission, total number of HH visits by discipline, HH length of stay. Financial Outcomes: revenue and net profit analysis vs. facility care.
RESULTS: Preliminary results for 44 patients: HH admission within 4 hours of hospital discharge; 4 visits from OT and 6 visits from PT within the first 7 days of HH; Three 30-day readmissions; TUG scores decreased 63 sec (avg); OASIS scores improved 17 points (avg); Cost exceeds HH reimbursement.
CONCLUSION: The SNF at home program may be operationally and clinically feasible. The clinical value of this program may impact future HH reimbursement, creating opportunity for OT. OT plays a pivotal role in home based functional recovery and medication management.
References
Augustine, M. R., Davenport, C., Ornstein, K. A., Cuan, M., Saenger, P., Lubetsky, S., ... & Siu, A. L. (2020). Implementation of post-acute rehabilitation at home: a skilled nursing facility-substitutive model. Journal of the American Geriatrics Society, 68(7), 1584–1593. https://doi.org/10.1111/jgs.16474
Levine, D. M., Cueva, M. A., Shi, S., Limaj, I., Wambolt, B., Grabowski, D. C., ... & Pu, C. T. (2022). Skilled nursing facility care at home for adults discharged from the hospital: a pilot randomized controlled trial. Journal of Applied Gerontology, 41(6), 1585–1594. https://doi.org/10.1177/07334648221077092
