For seniors, receiving skilled care at home – instead of at a skilled nursing facility (SNF) – could have considerable benefits, including better patient experience and lower costs.
That’s according to a study by researchers from Brigham and Women’s Hospital.
The study was conducted between August and September of 2019 and used a pilot trial where 10 patients were randomly assigned to rehabilitation-at-home (RAH) care. Half of the patients were treated at their homes and half were treated at a SNF. The pilot was similar to the one the same researchers performed about five years ago, which was the country’s first randomized control trial of hospital-level in-home care.
According to the study’s findings, RAH as a substitute for traditional SNF care has “favorable signals in patient experience, functional status, cost and days at home.” The researchers concluded that following a similar trial on a larger scale, RAH could become the standard.
Findings also showed the median cost of care for patients receiving RAH was $8,404, compared to $9,215 for the SNF residents.
David Levine, one of the study authors and the medical director of internal medicine at Brigham’s Division of General Internal Medicine and Primary Care, told Home Health Care News that the main takeaway from the study’s findings was not only the at-home option’s feasibility, but also that the at-home patients saw their functionality increase.
“I was truly surprised by the amazing difference in functional status changes that we saw between the control group and the home group,” Levine said. “People got so much more functionally at home. I’m not hanging my hat on these numbers. I’m just saying it’s a trend.”
Levine said patients receiving care at home, on average, had performed four and half more activities of daily living (ADLs) after 30 days of the pilot compared to one additional ADL performed by the SNF group.
Levine emphasized a number of times that a larger study would need to be done before he or any researcher definitively says that at-home SNF care would cut costs and be more beneficial for patients. However, the pilot study showed that improvements to the process are possible and that at-home care providers should be paying attention.
“These were very debilitated patients and we were able to show that it’s feasible,” Levine said. “Patient experience was so much higher for the ones at home than it was in the SNF group. We can carry out this care model and we can randomize patients. Now we need to do the rest of the work to replicate it in a bigger sample.”
As far as the future of SNF care at home, Levine hopes to see interest in larger studies to get a fuller picture of what this space could look like. He also expects at-home care providers to see this as an investment opportunity sooner rather than later.
“For some of the home health agencies as well as even hospitals, they should be reading this [study] and saying, ‘Wow, maybe this is something we need to think about investing in right now. If we invest in it now, by the time it’s really ready to roll, we’ll be ready and we’ll have the experience,’” Levine said.
He also pointed to the bipartisan effort that would give Americans more choice on where to recover following a hospital stay as evidence of a shifting landscape in the SNF-at-home space.
The bill — the Choose Home Care Act of 2021, which was introduced in the House of Representatives in October and in the Senate in August — would create an add-on payment to the traditional Medicare home health benefit for patients 30 days after hospital discharge.
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