Funded by grants from the Massachusetts Medicaid program, the University of Massachusetts and Mass General Brigham are each studying models for “skilled nursing facility [SNF] at home” care. Under both models, patients go directly home from the acute care hospital and receive nursing and therapy services as well as remote monitoring. KFF Health News highlights a 75-year old man who had broken his hip and, after a period of hospital care, was discharged home. A nurse associated with the UMass trial met him at his home “and showed him how to use a wireless blood pressure cuff, wireless pulse oximeter, and digital tablet that would transmit his vital signs twice a day.” Nurses visited him, physical and occupational therapists provided “several hours of treatment every day,” “a home health aide came a few hours a day,” and the clinical trial delivered three meals a day. The patient received considerably more professional therapy and aide services than he would have received in a skilled nursing facility. Similar SNF at Home programs, while uncommon because of the absence of reimbursement mechanisms, are underway in New York, Pennsylvania, and Wisconsin.
A key motivation for the SNF at Home movement is concern about patients who are backed up in hospitals, waiting for a nursing home bed. A 2022 Issue Brief by the American Hospital Association found a nearly 24% increase in average lengths of stay in acute care hospitals since 2019 and delays in hospital discharges, with patients waiting for post-acute care, primarily nursing homes and home care. The COVID-19 pandemic exacerbated discharge problems, as workforce shortages led to many nursing homes not accepting new patients. A December 2024 survey by the Massachusetts Health & Hospital Association found at least 1,995 hospital patients waiting for discharge, primarily to skilled nursing facilities (1058 hospital patients) and home health (643 patients). Many hospital patients went to a post-acute setting in 7-13 days, although 24 patients waited more than six months for a nursing home placement. Nearly half the hospital patients in Massachusetts waiting for post-hospital placement were covered by traditional Medicare and 11%, by Medicare Advantage.
April 3, 2025 – T. Edelman