Green House Project Expands Short-Term Rehab Focus to Meet Expected Demand

The Green House Project, a non-profit that offers alternatives to traditional nursing homes, this week launched an initiative designed to broaden its reach — including a financial feasibility model and a newfound focus on short-term rehab services.

Both financial feasibility and the growth of short-term rehab are looming factors in the skilled nursing world, where margins are dropping and managed-care payers demand shorter and shorter lengths of stay.

The seeds of the initiative began when the group acquired the trademark for Green House from founder Bill Thomas a little more than a year ago, Green House senior director Susan Ryan told SNN. With the challenges that nursing homes are facing, the Linthicum, Md.-based non-profit saw an opportunity to reach out to providers about the work it does in the short-term rehab space, she explained.


The Green House model was always visualized as a setting for long-stay residents, with small groups of 10 to 12 people living in home-like facilities with private rooms. But leaders at the non-profit began to see promise in short-term rehab at a home in Chelsea, Mass. that was specifically trying to improve its payer mix starting in 2009, Ryan said.

“They really pushed back and they said: ‘For us to meet our mission of serving a high percentage of Medicaid recipients, we need to add Medicare to our payers, and we believe this is how we will achieve the financial viability that will enable us to live our mission,'” Ryan told SNN.

Massachusetts nursing homes, like many others across the country, have been plagued by low Medicaid rates; SNFs in the state have also seen a decline in Medicare revenue, adding to their financial pressures.


As a result, in 2010, the Leonard Florence Center for Living earmarked three homes, or 30% of their total beds, for short-term rehab. Green House wasn’t sure whether the model would appeal to consumers, given its focus on providing a home-like setting and the fact that short-term rehab patients have a home to go to, Ryan noted. But their experience turned to be “a game-changing experience for Green House,” Ryan told SNN.

The lessons from the Leonard Florence Center for Living Green House has led to more and more homes adding short-term rehab to their payer mix, she added.

Debbie Wiegand, director of operations for the Green House Project, said one skilled nursing facility in Florida — The Woodlands at John Knox Village — drew heavily from the steps taken by Leonard Florence. The Woodlands, part of the John Knox continuing care retirement community (CCRC), has 12 Green House homes and opted to make four of them short-term rehab locations, with 48 rooms dedicated to that purpose, Wiegand told SNN.

“They are achieving a 99% average daily census in their short-stay homes, and the only reason they’re not 100% is it takes some time to clean the rooms properly before they can be turned over,” she said. “They’ve actually cornered the market in Broward County. The physicians that are discharging individuals from the hospital want them to go to the Woodlands.”

In addition, the length of stay for individuals there is shorter, resulting in savings for Medicare, Wiegand said. At John Knox Village, the average cost per case to the Centers for Medicare & Medicaid Services (CMS) was $8,603 over the last two years on average. That compared with $14,716 for the therapy management company that works with the CCRC, Wiegand said.

While about 12% of Green House homes currently offer short-term rehab, the number is definitely increasing — and the service is compelling from an occupancy standpoint, Ryan said.

Green House’s financial feasibility modeling tool measures the impact on what operators decide to do with the Green House model, and that includes what’s going to happen from a financial standpoint if an operator adds skilled nursing or decides to focus solely on long-term care, Wiegand noted.

“The costs are higher when you look at integrating skilled nursing, but the reimbursement rate is also going to compensate enough that it overcomes your cost,” she said.

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