After a piece of ice had sent Marc Durocher to the ground and doctors in the Umass Memorial Medical Center repaired the broken hip that resulted, the 75-year-old electrician was at an intersection.
He no longer had to be in the hospital. But he was still in pain, unstable on his feet, not ready for independence.
Patients throughout the country often walk at this intersection, stuck in the hospital for days or weeks because nursing homes and physical rehabilitation facilities are full. But when Durocher was ready for dismissal at the end of January, a doctor came along with a surprising path: do you want to go home?
In particular, he was invited to participate in a study at the Umass Chan Medical School in Worcester, Massachusetts, which tested the concept of “SNF home” or “Subacute Home”, in which services are usually offered in a skilled nursing institution instead in the house, with visits of care providers and monitoring technology.
Durocher hesitated, was afraid that he might not get the care he needed, but he and his wife, Jeanne, finally decided to try it. What could be better than recovering in his house in Auburn with his dog, Buddy?
Such a rehabilitation at home is underway in different parts of the country – including New York, Pennsylvania and Wisconsin – as a solution for a shortage of nursing home and rehabilitation beds for patients who are too sick to go home, but not sick enough to need hospitalization.
Personnel shortages at post-acute facilities throughout the country led to an increase of 24% in three years in the stay of the hospital in patients who need competent nursing care, according to an analysis of 2022. Without a place to go, these patients occupy expensive hospital beds that they do not need, while others are waiting for the first aid in those places. In Massachusetts, for example, at least 1,995 patients waited at the hospital in December, according to a study under hospitals by the Massachusetts Health & Hospital Association.
Offering intensive services and external monitoring technology can work as an alternative – especially in rural areas, where nursing homes close faster than in cities and the patient’s family members often have to go far to visit. For patients of the Marshfield Clinic Health System who live in the Wisconsin countryside, the six-year-old SNF-at-home program of the clinic is often the only option, said Swetha Gudibanda, medical director of the hospital program.
“This will be the future of medicine,” said Gudibanda.
But the concept is new, an outgrowth of hospital home services extensively extended by a COVID-19 Pandemic inspired Medicare exemption. SNF-at-Home Care remains unusual, lost in a tax and regulatory Netherworld. No federal standards describe how these programs should be carried out, that patients must qualify or what services they must offer. There is no reimbursement mechanism, so Fee-For-Service Medicare and most insurance companies do not cover such care at home.
The programs have only emerged in a few hospital systems with their own insurance companies (such as the Marshfield Clinic) or those who arrange them for “bundled payments”, in which providers receive a fixed fee to manage a delivery of care, as can occur with Medicare Advantage plans.
In the case of Durocher, the care was available – without costs for him or other patients – only through the clinical study, financed by a subsidy from the State Medicaid program. State Health Officers supported two simultaneous studies at Umass and Mass General Brigham in the hope of reducing costs, improving the quality of care and, crucial, makes it easier to switch patients from the hospital.
The American Health Care Association, the trade group of nursing homes with profit motive, calls “SNF at home” a wrong name because, according to the law, such services must be provided in an institution and meet detailed requirements. And the association points out that competent nursing facilities offer services and socialization that can never be replicated at home, such as daily activity programs, religious services and access to social workers.
But patients at home stand up to get up and move more than those in a facility, accelerate their recovery, said Wendy Mitchell, medical director of the Umass Chan Clinical Trial. Therapy is also tailored to their home environment, where patients are taught to navigate through the exact stairs and bathrooms that they will ultimately use alone.
A quarter of people who go to nursing homes suffer from ‘side effects’, such as infection or bed, said David Levine, clinical director for research for Mass General Brigham’s Healthcare at Home program and leader of her studies. “We cause a lot of damage in facility care,” he said.
In 2024, on the other hand, no patient developed a bed in Nashville in the rehabilitation care of Contessa Health in Nashville and only 0.3% came up with an infection with an infection, according to internal company data. Contessa provides care through partnerships with five health systems, including the Mount Sinai Health System in New York City, the Allegheny Health Network in Pennsylvania and the Marshfield Clinic van Wisconsin.
The Contessa program, which has been offering rehabilitation in the home base since 2019, depends on the help of unpaid caregivers. “Almost universal our patients have someone who lives with them,” said Robert Moskowitz, acting president of Contessa and Chief Medical Officer.
However, the two Massachusetts -based studies register patients who live alone. During the UMASS test, an overnight houses for home can remain a day or two if necessary. And while they are alone, patients have “access to one button to a living person from our command center,” said Apurv Soni, a university teacher of medicine at Umass Chan and the leader of his studies.
But SNF at home is not without dangers and choosing the right patients to register is crucial. The UMass research team learned an important lesson when a patient with mild dementia was alerted by unknown care providers who came to her home. According to Mitchell, she was again admitted to the hospital.
The mass -general Brigham study is highly dependent on the technology intended to reduce the need for highly skilled staff. A nurse and doctor each brings a home visit, but the patient will otherwise be checked remotely. Medical assistants visit the house to collect data with a portable ultrasound, portable X -rays and a device that can analyze blood tests on the spot. A machine that does the size of a toastery ovtier issues medication, with a robot arm that drops the pills in a dosing unit.
The Umass test, the only Durocher who registered, chose a “light touch” with technology instead, with just a few devices, Soni said.
The day Durocher went home, he said, a nurse met him there and showed him how to use a wireless blood pressure cuff, wireless pulse oximeter and digital tablet that would send his vital plates twice a day. In the coming days, he said, nurses came by to take blood samples and to control him. Physical and occupational therapists provided a few hours of treatment every day and home health assistance came a few hours a day. To his delight, the program even sent three meals a day.
Durocher learned to use De Walker and how to get up the stairs to his bedroom with one stool and support from his wife. After just one week, he switched to less frequent, home bodry therapy, covered by his insurance.
“The recovery is great because you are in your own setting,” said Durocher. “To be banished to a chair and a walker, and initially someone who helps you to get up or go to bed, to shower – it is very humiliating. But it’s comfortable. It’s at home, right?”
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