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Medicare spending on this “post-acute care” increased from $29 billion to $59 billion between 2001 and 2013.
Some boast hotel-like features. Spas. Hair salons. Bistro-style dining.
These days, brochures of nursing homes often feature pictures of active-looking seniors undergoing rigorous-looking exercises and phrases such as “short-term rehab” or “transitional care” or “bridge from hospital to home.”
The past decade has brought huge change in the nursing home industry, with many now trying to market themselves as akin to inpatient rehab hospitals.
Increasingly, there are separate nursing home wings – or even separate buildings – for short-term customers who need rehab after a hip replacement or to regain strength after a bout of pneumonia.
To the casual observer, the new digs – which nursing home operators often deliberately keep separate from the dementia wing or other long-term-care units – can look quite plush, making a post-hospital stay seem akin to a vacation. But experts say the many new choices for post-hospital care mean Medicare beneficiaries need to become more informed consumers and understand that the word “rehab” can mean different things in different settings.
Rapid Growth of Post-Acute Care Centers
Medicare spending on what’s more accurately labeled by the government as “post-acute care” has nearly doubled, going from $29 billion to $59 billion a year, between 2001 and 2013, according to an analysis last year by the Agency for Healthcare Research and Quality.
Fueling this fast growth in new post-hospital care centers are Medicare reforms, such as provider penalties and bundled payment incentives, which are aimed at preventing “bounce-backs” – patients who are re-hospitalized for the same condition because they lacked good follow-up care.
Major nursing home chains and small independents alike have been investing in renovations and upgrades aimed at meeting the demand for more short-term stays, with the incentive being that such patients command a higher reimbursement rate from Medicare. At the same time, many hospitals have either established their own rehab centers or partnered with nearby nursing homes or community home-health providers to offer such step-down care in arrangements known as “accountable care organizations.”
Innovation in Post-Rehab Care
The trend is primarily positive for older people, who can only benefit from their doctors and caregivers being more vigilant in making sure they get proper post-hospital care.
In many cases, rehabilitation services are now being marketed directly to consumers, who in the past were expected to just choose a facility from a list handed to them a day or two before their discharge from a hospital.
Genesis HealthCare, one of the country’s larger nursing home chains with 439 facilities in 39 states, is among the many long-term-care companies trying to persuade consumers to assert more control over post-hospital rehab decisions.
Genesis created a new division called PowerBack Rehabilitation and four years ago began building the first of what will soon be 12 standalone rehabilitation centers, said Carol Rohrbaugh, vice president of business development.
The company distributes a PowerBack preferred customer card, much like the cards hotel chains give out, as a way to get more consumers to consider pre-booking a rehab stay ahead of a scheduled surgery.
Movement Towards More-Informed Decision-Making
“Most people choose a rehab facility on location, which when you think about it, is not a very good criteria,” Rohrbaugh said.
Nursing homes can vary greatly in the staffing levels of doctors, nurses and physical therapists, but consumers will have very little time to research such differences if they wait until after an emergency hospital stay, she added.
“There are a lot more choices for patients leaving the hospital, but the concern is that some people might not fully understand the choices,” said Dr. Bruce Pomeranz, senior medical officer at Kessler Institute for Rehabilitation in West Orange, NJ.
Under Medicare’s new culture of encouraging hospitals to form partnerships with other care providers who all agree to accept one negotiated “bundled” payment, consumers could be steered to a lower-care level facility simply to save money instead of the decision being guided by treatment needs, Pomeranz said
Nursing homes’ post-acute wings aren’t always appropriate rehabilitation sites for patients recovering from major health events, such a serious trauma or a debilitating stoke, Pomeranz said. Inpatient rehab hospitals like the nearly 70-year-old Kessler institution are licensed and regulated more rigorously and are required to have doctors, nurses and therapists with special training in rehabilitative care.
“Not everybody needs that level of complex care, but some do,” Pomeranz said. If someone is just recovering from a bad case of pneumonia, “a nursing home might be the perfect place for them” to receive post-acute care. “But if they suffered a major stroke or a major trauma, then they might need more specialized medical care that isn’t available in a nursing home,” he added.
Patients and families should seek help in trying to gauge the most appropriate placement by exercising their right to an evaluation of their rehabilitation needs before discharge, he said.
It’s worth noting too that under Medicare managed care plans, consumers may already be locked into receiving rehab services from a facility in-network. So increasingly it may be just as important for Medicare beneficiaries to research which rehabilitation providers are covered under a plan each year during open enrollment season, the same way they might research whether their cholesterol medicine or their cataract surgeon is covered.
What’s in Store for the Future of Post-Hospital Care
Making a post-hospital care decision could get easier in the future.
In response to the sharp growth in post-acute care services, Congress in 2014 passed a new law that seeks to provide consumers and government with more data on the outcomes and costs of post-acute care. The law requires federal regulators to devise standardized assessments for post-acute centers so that they can be compared on a more even playing field. But that data isn’t expected to be available to the public until 2018 at the earliest.
How to Decide on a Post-Acute Care Facility
In the meantime, consumers should seek to ask a lot of questions of their own before choosing a post-acute care facility. Here are a few suggested ones:
- Do I need a level of rehabilitation that must be supervised by physicians across many specialties, something available in a rehab hospital but not in a nursing home?
- What are the staffing levels of nurses and nurse’s aides across all shifts?
- How much physical, occupational or other types of needed therapy can I expect to receive there and is it available seven days a week or only five?
- What kind of rehabiltation and therapeutic technology is on-site and in-use?
- Do the physicians, nurses, and therapists have special training and experience treating my condition?
- Are patients at the facility regularly seen by a physician and if so, how often?
- What are the facility’s outcome statistics and how many patients with my condition are able to return to independent living at home?
- Does the facility have a process for arranging for the home care that still might be needed once I’m ready to leave a post-hospital center?