A first-of-its-kind clinical trial will investigate the feasibility of providing post-acute skilled nursing facility care to patients in their home as a way to help alleviate the skilled nursing crisis and improve patient outcomes.
The Skilled Nursing Facility or SNF at Home trial is a large, randomized clinical trial being conducted by the UMass Chan Medical School and is supported by a $6.5 million grant from the Massachusetts Executive Office of Health and Human Services.
The medical school researchers will begin enrolling patients this summer from their UMass Memorial Health and Baystate Health clinical campuses to study post-acute skilled nursing facility services provided in patients’ homes following hospitalization. The plan is to enroll 650 patients in the program.
Researchers say the study is an effort to find a solution to the shortage of skilled nursing beds in the state and nationally and to reduce patient rehospitalizations.
“Many patients over the age of 60 require some kind of facility-based rehab and 90% of those patients end up going to a skilled nursing facility,” the study’s principal investigator Apurv Soni, MD, PhD, assistant professor of medicine and co-director of the Program in Digital Medicine at UMass Chan Medical School, told McKnight’s Long-Term Care News.
“The problem we have here in Massachusetts, and more broadly nationally, is there are not enough skilled nursing beds for the patients that need that kind of care and so many of the patients are waiting in the hospital to be discharged to one of these facilities,” he said.
Soni believes the SNF at Home model has the potential to be more effective and safer in providing rehabilitation care for these patients than in a skilled nursing facility. First, the patients will be doing their daily exercises in a home setting that they’re familiar with versus a controlled environment. In addition, since the patients will be transitioning directly from the hospital to the home, there is less potential for problems occurring during transition, such as the risk of falls or medication gaps, he said.
Soni emphasized, however, that the SNF at Home model is not trying to replace or compete with care at skilled nursing facilities but to complement them. If successful, he believes their study can serve as a model for nursing homes looking to start their own SNF at home programs.
“While this intervention model is being set up by the hospitals, we anticipate this model could be set up in skilled nursing facilities as well,” he said. “This is just one of the ways that we have of tackling the bed (shortage) problem for acute and post-acute patients.”
The goal of the SNF at Home trial is to improve rehabilitative care and quality of life for these patients, without sacrificing the safety of a skilled nursing environment. Soni noted that a quarter of skilled nursing facility patients currently return to hospital within 30 days.
The SNF at Home trial will measure rehospitalization and assess patients’ functional status and satisfaction. It also will compare costs of providing skilled nursing facility care in a patient’s home with those of inpatient skilled nursing facility care.
Soni emphasized that patients enrolled in the Skilled Nursing at Home program will primarily be those with short-term rehabilitation needs rather than those who need long-term care.
“We’re not trying to study this model for patients that end up requiring long-term care for rehabilitation,” he said. “We anticipate this being for short-term or subacute patients.”
