SNF-at-home programs are gaining traction as a viable solution to address the shortage of nursing home and rehabilitation facility beds, with the goal of reducing bottlenecks at hospitals.

Indications of success of SNF-at-home programs – although mostly anecdotal at this moment – are evident from two simultaneous studies at UMass Chan Medical School and Mass General Brigham as well as results at several SNF-at-home programs.

Dr. Apurvi Soni, assistant professor of medicine who leads the UMass Chan Medical School research study, told Skilled Nursing News that since the trial is still in progress, he was unable to share data on rehospitalization rates measuring its success, but the feedback from enrolled patients being discharged to their home instead of a nursing facility are encouraging.

“[O]ur patients are very elated to get randomized to the home arm,” Soni said. 

Besides measuring clinical success, one of the goals of the UMass research study is to also investigate how costs of SNF at-home care compared to nursing home care, he said.

SNF-at-home programs offer patients the ability to recover at home with the help of physical therapists, home health aides, and remote monitoring devices. And this approach provides an alternative for patients who no longer need hospital care but are not ready for independence.

Aside from the Massachusetts test sites, such programs are underway in several regions, including New York, Pennsylvania, and Wisconsin, according to a KFF Health News article.

Rehab at home can be especially useful in rural areas, where access to nursing homes is problematic due rising closures.

For example, in Wisconsin, the Marshfield Clinic Health System’s SNF-at-home program, which has been operating for six years, is often the only option, Swetha Gudibanda, medical director of the hospital-at-home program, told KFF News.

“This is going to be the future of medicine,” Gudibanda said.

These programs have also shown fewer adverse outcomes for patients, such as bed sores and infections.

In a program run by Nashville-based Contessa Health, not a single patient developed a bed sore and only 0.3% came down with an infection while at home, according to internal company data from 2024 shared with KFF. The program relies on family caregivers and partners with five health systems, including Mount Sinai and Allegheny Health Network, the KFF article notes.

However, despite its successes, the SNF-at-home concept faces challenges due to lack of federal standards, clarity on which services should be offered, no reimbursement model, and the need for careful patient selection.

Moreover, it’s difficult to tell how widespread these programs are across the U.S. Fee-for-service Medicare and most insurance companies don’t cover such care at home. Hence, the programs are limited to hospital systems with their own insurance companies or those using “bundled payments,” where providers receive a set fee to manage care, such as with Medicare Advantage plans.

“SNF-at-home in its truest form does not exist very much outside of specific situations and in value-based programs,” Soni said in an emailed statement to SNN. “What I mean by that is that there are some rehab programs that try to provide enhanced home-health services but rarely any that are a true substitute for a SNF,” he said.

However, the need for an alternative to hospital care or nursing home care is enormous. Staffing shortages at post-acute facilities around the country have led to a 24% increase over three years in hospital length of stay among patients who need skilled nursing care, according to a 2022 study from the American Hospital Association noted in the KFF piece.

And, one in five hospital patients with Medicare are admitted to some level of rehabilitation facility after their inpatient stay.

“We already have a crisis there, because there aren’t enough skilled nursing facilities,” Soni said earlier. “From a health system perspective, being able to have an enhanced program that you can discharge patients to is very important.”

The outcomes for patients admitted to skilled nursing facilities aren’t as successful as they should be, and one in four of those patients end up back in the hospital within 30 days, Soni said.

And transitioning to home for rehab seems to speed recovery, Dr. Wendy Mitchell, medical director of the UMass Chan clinical trial, notes in the KFF article, because therapy is tailored to their home environment, enabling patients to navigate the exact stairs and bathrooms they’ll eventually use on their own.

The Mass General Brigham study uses technology to reduce reliance on skilled staff, with in-home visits from a nurse and physician, while medical assistants remotely monitor the patient using portable equipment for ultrasounds, X-rays, and blood tests.

UMass Chan Medical School’s randomized clinical trial, for which researchers first began enrolling patients last summer, is supported by a $6.5 million grant from the state. It aimed to enroll 650 patients who were eligible for inpatient-level skilled nursing care following acute hospitalization.

The Massachusetts-based studies also offer services like overnight aides and remote access to live support. However, selecting the right patients is crucial, as demonstrated when a patient with mild dementia was readmitted after becoming distressed by unfamiliar caregivers. 

In the test case of the SNF-at-home program for Mass General, after returning home, a patient might receive guidance on using remote health devices to track vital signs, with nurses visiting regularly for blood samples and check-ups. Physical and occupational therapists are on hand to provide daily treatment, while a home health aide is available to assist a few hours each day, and daily meals provided.

The patient profiled in the KFF article reported using a walker and navigating stairs with support, and transitioning to less frequent in-home physical therapy after a week of being at home.