Some SNF Operators Specialize to Take on High-Acuity Patients

With fewer hospital referrals coming in, and a sicker patient population post-COVID, some operators are finding ways to stand out by specializing in specific areas of medicine to help bring in higher acuity patients.

As Martin Siefering, principal at architecture firm Perkins Eastman, put it, nursing homes have more beds than they need right now and while renovations and redesigns are an expensive undertaking, the nursing home industry is in need of a facelift.

“If we have 1.6 million beds and there’s around 30% vacancy right now … it’s going to go higher but is it going to go back up to the rates we were running before? I doubt it,” he told SNN.


Creating specialized programs in big need areas at the moment such as respiratory and cardiac and bringing in medical experts are two ways SNFs are attempting to change their identities and prove they are capable of taking on higher acuity patients.

At The Allure Group, based in New York, a multimillion-dollar renovation was recently completed at its newest acquisition, the King David Center, a 271-bed SNF in Brooklyn.

The New York-based operator, with a network that includes 1,446 beds at six facilities, hopes to make it a destination facility for neurological rehabilitation for years to come.


Part of the renovation included a newly installed aquatherapy pool, designed to give patients suffering from Parkinson’s Disease in particular the ability to improve their mobility, balance and fitness with therapy.

“While we don’t have objective data directly correlated to the quantity of referrals as a direct result of the aqua therapy pool, we have noticed a significant increase in census at King David Center,” Matthew Fenely, chief business development officer for The Allure Group, said. “The pool has allowed us to capitalize on therapeutic gains even earlier in the recovery process for a wider range of clinically complex patients due to body weight suspension.”

With an underwater treadmill and resistance jets, aquatic physical therapy has been shown to improve lower-body strength and the center of gravity for older adults.

In one study, conducted at Utah State University, individuals with osteoarthritis displayed reduced joint pain and improved balance, function and mobility after six weeks of aquatic treadmill exercise

“Most of [the patients] are in a wheelchair,” Lorelie Mercado, director of rehabilitation at the King David Center, explained. “You can see how they’re able to move better and how they participate much more in the exercises the therapist gives them.”

The pool serves as the centerpiece for King David Center’s push to become the best post-acute facility for neurological rehabilitation in the area as The Allure Group looks to create a niche at each one of its facilities, Fenley explained.

“We were pretty in tune with accepting higher acuity patients pre-pandemic and I think we fared better than most,” he said. “We’re not back to pre-pandemic levels, but we like the direction that things are heading right now.”

While King David Center serves as a base for neurology patients for the SNF, others in The Allure Group serve different clinical niches.

“Hamilton Park being our ventilator facility, there’s certainly a focus on respiratory there,” Fenley explained. “Our Bedford Center facility, we’re really honing in on cardiology, we have launched a cardiac rehab program there. Linden Center has launched a dementia unit.”

Growing need for medical direction

Skilled nursing facilities are required to have a medical director — a physician responsible for coordinating care in their facility — and though they account for only 1.65% of nursing home staff, it’s an area many SNFs are looking to improve in order to bring in higher acuity patients.

Dallas-based GAPS Health — an acronym for “Geriatric Administrative Provider Services” — provides medical directorships to SNFs across the U.S. and CEO Jerry Wilborn said the company quadrupled in size over the course of the pandemic.

“What’s going to be left in the wake of the pandemic is increased acuity,” he said. “There are a number of chains that we know are looking for specialized programs, whether it be dialysis or respiratory. However it is configured, it needs to be configured in lockstep with the hospital.”

The pandemic showed the need for increased clinical coverage across all SNFs, he said.

“There’s a lot of clinical activity in a SNF, certainly not as much as we’d like to see on the physician side and there’s certainly a paucity of doctors and physician leadership,” Wilborn added.

He argued that starting a specialty program to fill beds is a good approach for SNFs, but an even better one is to establish referral streams through physician-led relationships with hospitals.

Wilborn felt the pandemic has shown the need for more physician leadership in SNFs.

“There’s a real need for clinical leadership and true medical direction [at SNFs],” he said. “There are facility owners and operators who have come to that conclusion, and we’ve been fortunate to partner with some of them.”

As part of launching its neurological rehabilitation program, the King David Center brought in Dr. Miran Salgado, The Allure Group’s chief neurological clinician to lead the team.

“He oversees the program itself, comes to the facility once a week and does rounds on each of his patients,” Fenley said. “Salgado is a world-renowned physician who really focuses on the Parkinson’s community.”

The Allure Group is hardly the only SNF bringing in specialists to help out.

Board-certified nephrologist Youssef Hokayem will be heading Baltimore-based Westgate Hills Rehabilitation & Healthcare Center’s recently launched chronic kidney disease management program, which will include onsite hemodialysis.

Currently serving as the medical director of Washington Nephrology Associates, Dr. Hokayem is highly regarded for his work in nephrology and has specialized expertise in hemodialysis in the nursing home setting, according to a press release from Marquis Health Consulting Services, which supports the facility. 

Designing new specialty programs not only attracts more complex residents but is something that hospitals look for when trying to find SNFs to partner with.

Partnering with hospitals

One trend that hospitals are seeing is an increase in respiratory programs to match an increase in acuity coming out of COVID, Kerrie Samuelian, system manager of post-acute transitions at Edward-Elmhurst Health,told SNN.

“Several of our area facilities have implemented hemodialysis programs over the last year,” she said of the Illinois based 736-bed hospital system. “They have brought onboard respiratory programs. A lot of them didn’t have respiratory therapists pre-COVID. Now they almost all have some form of respiratory program.”

She felt the trend for higher acuity patients for SNFs started with the shift to the Patient-Driven Payment Model (PDPM) in October 2019 and, over the course of COVID, has become more pronounced. It’s not just one or two SNFs making this transition but something she is seeing repeatedly across their network.

“Even some of the buildings that were primarily your hips and knees type places, they are taking more acute patients and they’re really working with our post-acute providers and our physicians to learn how to care for those patients individually,” she explained. “As you take one you kind of get better at it as you work with us in the hospital.”

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