The SNF at Home Model and Home Care

Home care agencies know keeping people at home is the preferred option. When asked what they fear most, seniors rated loss of independence (26%) and moving out of home into a nursing home (13%) as their greatest fears. Death was cited as the greatest fear for just 3% of seniors.[i]  According to one AARP survey, roughly 90% of American seniors want to stay in their home for as long as possible. The discussion of home versus a nursing home has been debated for many years. COVID-19 has elevated the discussion to an actionable model. As a result, more seniors and their families are looking for higher acuity care in the home setting.

The Skilled Nursing Facility (SNF) At Home model addresses this need by combining skilled care for those higher acuity patients in a home setting instead of a SNF setting. In other words, it is meant for short-term traditional SNF stays, which now can be done at home. The goal of the SNF at Home idea is to lower cost, hospital readmissions, and improve patient satisfaction.

According to Home Care 100, there are two versions within the SNF at Home model:

SNF at Home “Light” is the familiar combination of home health and personal care. This would be similar to a partnership between a home health and home care agency today.

SNF at Home “Full Blown” is a combination of Home Health, Personal Care, Remote Patient Monitoring, physician and nursing Services, meal/nutritional support, and Durable Medical Equipment needs. The full-blown version will likely face reimbursement challenges. The cost of implementing and coordinating these services from possibly five different providers could prove to be a challenge. 

The Medicare Payment Advisory Commission (MedPAC) has been working on a unified payment model solution that would tie the reimbursement to the condition rather than the setting allowing the patient’s care to be in the home.

All of this is good news for patients, but what does this mean for home care?

First, let’s look at who will likely engage in the SNF at Home model?

  • Home Health Agencies – Obviously, home health agencies will promote their experience and history, especially with the light version. Home health agencies will target hospitals to partner in discharging patients to their care instead of a skilled nursing facility.
  • Skilled Nursing Facilities – SNFs are at the greatest risk. SNF’s occupancy rates continue to see record lows. Although the decline has slowed down, SNFs are evaluating what their next step is for survival. It would be a natural step for them to add the at home model.
  • Senior Living Communities – The senior living communities prior to COVID were already in a state of instability with a caregiver shortage, more active retirements, longer life span, and demand for care at home. As any industry needs to pivot to meet consumer demands, senior living communities will do the same. Adding the SNF at Home model will create a value add, which they hope will increase residents. 
  • Hospital at Home Programs enables patients to receive hospital-level care in their homes will likely consider adding this model. 2) Partnering with a home health agency will allow them to focus on skilled care while the home care agency takes care of the personal care side. Approximately 80 hospitals, including John Hopkins, are piloting it. This model is already used in England, Canada, and Israel. The idea is the reduction of cost and readmissions and better patient outcomes. Hospitals participating in this model are likely to add SNF at Home to provide continuity of care and retain additional revenue.

Home care agencies have an opportunity to join the SNF at Home model. In both versions, personal care is needed. Traditionally, none of the ones mentioned above are experts at providing non-medical home care. In essence, each of them will need personal care to roll out the program successfully. 

According to Home Health News, most home health providers have embraced the SNF-to-home model. Many have launched dedicated SNF-at-home programs that pair skilled home health services with non-medical home care capabilities. Partnering with a home health agency will allow them to focus on skilled care while the agency takes care of the personal care side. Skilled Nursing Facilities likely will not have the in-home experience, which would be a good opportunity for a home care agency to be the expert in rolling out the program. Senior living communities have always been a good resource for a partnership to deliver at home services. This partnership would allow them to focus on what they are good at while expanding their services to attract more residents. Lastly, hospitals often don’t understand or sometimes discount non-medical in-home care. Many have tried it, and many have failed. Be a resource. Hospitals can and will benefit from good home care agencies to support both the hospital to home and SNF at home models.

The SNF at Home model is in its infancy, and now is the opportunity to get involved and support the skilled side of the model. 

Do your research. Is SNF at Home being considered in your area? If so, join them. If not, proactively reach out to potential partners to lay the groundwork to launch it. Home Health News offers  The Secret to Setting Up Shop in the SNF-at-Home Space to get you started.

Seniors Fear Loss of Independence, Nursing Homes More than Death,, 11-12-2007

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