AHCA refutes recommendations that most stroke patients should skip nursing homes

Long-term care's largest provider group is firing back over a “frustrating” recommendation that the majority of stroke patients should be treated in an inpatient rehabilitation facility rather than a nursing home.

The recommendations, released earlier this month by the American Heart Association/American Stroke Association, stated that stroke patients should receive care in an inpatient rehabilitation facility “whenever possible,” unless they have a health condition that would require more skilled nursing care.

Those recommendations only focused on the “minimum capabilities” of nursing homes, and failed to take into account facilities that focus on rehabilitation and demonstrate positive outcomes for stroke patients, Dan Ciolek, associate vice president of therapy advocacy for the American Health Care Association, told McKnight's.

“Some SNFs have focused on rehab care and have changed what they do, and may be able to do it at the level of an IRF,” Ciolek said. “The underlying thing is that the assumption that people can't get better going to a nursing home needs to be stopped.

Providers who do offer increased levels of therapy should focus on showing evidence of how many stroke patients they treat, how many of them return home with improved function and other evidence of positive outcomes. That evidence can help set nursing facilities apart, and show stroke patients and hospitals which local providers can give the best services for their needs, Ciolek noted.

“It's frustrating that the perception is that level of care can't be provided,” he said.

Despite the outcry from providers, the intention of the recommendations wasn't to dispute the value of skilled nursing care, Joel Stein, M.D., co-chairman of the stroke guidelines committee, told McKnight's.

“All of the studies [used in the recommendation] rather consistently found that outcomes for stroke patients are better in acute-level rehabilitation than in skilled nursing rehabilitation,” Stein said. “I would certainly not dispute the value of SNF care, the guidelines were not intended for that.”

Skilled nursing care isn't a “bad thing” for the “right” stroke patients, although the guidelines focus on patients who qualify for and have access to acute rehabilitation, Stein added. He also acknowledged that some skilled nursing facilities can provide as much therapy as an inpatient rehabilitation facility.

The AHA/ASA recommendations may still cause doubts among patients who do go to nursing homes for care after a stroke, and push people to “ignore” the facilities' therapy qualifications, Ciolek noted.

“The great majority of people that have strokes do get IRF care but not all do,” he said. “People that end up going to a SNF for care shouldn't feel like they're getting secondary, lower-level care.”

The quality of care provided by skilled nursing facilities is one of several hot-button issues AHCA members are expected to tackle during today's Congressional briefing.