As more operators look for ways to add SNF-at-home services to their offerings, staffing shortages may continue to stall home recovery care expansion in the post-acute care space.

Some home care providers like Contessa are working to add SNF-at-home programs to more markets.

For SNF operators, however, reimbursement remains a challenge in launching home care programs though it may have considerable benefits including better patient experience and lower costs.

Rehabilitation-at-home (RAH) care, which included nursing care and 1.5 hours of therapy five days per week, reduced the median cost of care; patients receiving RAH was $8,404, compared to $9,215 for SNF residents, a recent study from Boston-based Brigham and Women’s Hospital showed.

Participants were selected at random to participate, half in the RAH group and the other half in the traditional SNF care group, and were enrolled between Aug. 8, 2019 and Sept. 27, 2019.

The researchers saw SNF costs as high, accelerating and variable, making shifting care to the home worth further exploration.

Upon admission to the home, patients in the RAH group received visits from a certified nursing assistant (CNA) and a geriatric medicine attending physician. On subsequent days the CNA visited daily, with the nurse available for as-needed virtual and in-person consultation, according to the study.

The CNA facilitated medication administration via an automated remotely programmable medication dispenser and physicians were updated daily by the CNA via video, voice, and/or text. Tailored to patients’ needs, a home health aide (HHA) was present in the home up to 24 hours per day.

RAH as a substitute for SNF care “demonstrated signals toward improved patient experience, functional status, cost, and days at home with similar length of stay and quality,” according to the study.

“The ability for a patient to rehabilitate in the comfort of their own familiar environment surrounded by their family and friends cannot be understated,” the authors added.

However, during a time when staffing is still a major challenge for the industry, the feasibility of this model continues to be questioned.

Over 238,000 caregivers have left the profession since the start of the COVID-19 pandemic, and with staffing challenges creating further capacity issues on the health care system, at-home services are expected to continue to grow.

From 2019 to 2029, there will be an estimated 7.4 million direct care openings, according to a report released by PHI National, a New York City-based policy research and advocacy organization.

“On the one hand, it largely reduces the nursing and physician requirements compared to a traditional SNF,” the researchers wrote. “On the other hand, there is an increased need for HHAs, which cannot be shared among patients as they are in a SNF. Given the training and pipeline requirements for clinicians, we feel this model may prove to be a net benefit to the industry.”

Further investigation into the labor requirements and the personnel required in both settings is suggested.

Still, the authors felt the study reinforces some interesting questions raised in recent years around the true value of SNF care.

David Levine, one of the study authors and the medical director of internal medicine at Brigham’s Division of General Internal Medicine and Primary Care, told SNN sister publication Home Health Care News that the landscape may be shifting in the SNF-at-home space as Americans now want more choice on where to recover.