Rehabilitation Feature: Rehab's revival

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More skilled nursing facilities are turning to therapy services to bolster their bottom lines. A new rule is nudging providers along.

You don't hear the phrase "old folks home" too often anymore. Years ago, the well-worn moniker was a suitable one. It summed up a facility's purpose of housing older adults at the end of their days.

But as facilities' role in the healthcare spectrum has changed, the old language no longer applies. Today, facilities not only care for those who can no longer take care of themselves, but they also treat those who are on the mend, -- recovering from surgery, for example. In such cases, a nursing home stay is merely a temporary stop on the way back to independent or semi-independent living.
As they were a decade ago, nursing homes today more and more are the healthcare setting of choice for post-acute therapy services. Following the enactment of the Prospective Payment System, facilities have turned to therapy to bolster their bottom lines. Short-term stays bring in precious Medicare funds that can compensate for marginal gains from Medicaid.
From the government's point of view, SNFs are also a good place for rehab. It is less expensive to treat a patient from the hospital who just had a hip or knee operation at a skilled nursing facility than at an inpatient rehabilitation facility (IRF). Federal officials enacted the so-called 75% Rule more than a year ago to encourage more therapy at SNF settings.

Rehab incentives
A more severely acute resident population is a main reason for offering rehab, says David Gentner, vice president of health services at The Wartburg Adult Care Community, of Mt. Vernon, NY. Funding shifts from skilled nursing into adult care and home health services is another.
While his 40-bed rehab unit is the most expensive unit to operate in his 240-bed facility, it also is likely the most profitable.
 "The days of these great big nursing homes are over, where people would live for many years sponsored by Medicaid," he said. "From a business model perspective, we as nursing home operators have to do this because more and more of us will go out of business because you can't do Medicaid long-term care."
Other experts second Gentner's thoughts.
"Most long-term care facilities that want to survive in today's market have to operate the facility on a rehab model basis or they're just not competitive in the market," said Jerry Lewis, president of Evergreen Rehabilitation, Louisville, KY, a contract speech, physical and occupational therapy company for nursing homes.
Unlike years past, residents are coming into long-term care facilities and want to go home, he said.  Most residents his company treats are orthopedic hip patients who have undergone hip, knee and shoulder repairs or any type of orthopedic procedure. His company also sees residents with wounds who need therapy to circulate blood flow to the afflicted area.

New joints to fix
Changing demographics have played a major role in growth of therapy services in skilled nursing facilities in recent years, people in the industry say. People are living longer and getting new hips, knees and shoulders along the way. These types of surgeries require rehabilitation.
"Before, people didn't live long enough to need a replacement," said Dick Herrick, president and CEO of the New York State Health Facilities Association.
"Today, 70-somethings are getting the procedure, but because of their age and other medical conditions, they may spend twice as long getting better in a rehab facility," he said.
Due in part to the rise of assisted living, nursing homes are now receiving residents with a higher average level of acuity and more comorbidities than in the past. That, too, results in greater utilization of rehab.
Government policies also have fueled a resurgence of rehab in SNFs. The therapy pendulum has swung back to long-term care, according to Kim Lee-Newman, director of rehabilitation for MBS Rehab of Austin, TX. About 10 years ago facilities were also offering rehab, but the PPS system that was put in place in 1999 jolted the payment system facilities knew into disarray.
"Now we're s