Changing regulations and payment models, along with evolving resident preferences and acuity are pushing skilled nursing operators to grow and diversify therapy services in-house or with a partner.

Outsourced therapy providers, in particular, have shifted their business model to focus more on clinical specializations and value-added services rather than volume. For providers of in-house therapy, flexibility in delivery has become essential, with operators like Illinois-based Ignite Medical Resorts adopting a hybrid therapy model helmed by forward-thinking leaders and aided with cutting-edge robotics technology, according to Mat Thengil, COO for Ignite.

Both in-house and outsourced therapy options have helped operators lessen staffing shortages while improving patient and therapist safety through these evolutions in service delivery and specialized offerings.

Outsourced therapy providers have historically helped nursing homes maximize revenue, said Melinda Butler Henderson, chief development officer for BenCura Rehabilitation Services. This is especially true when payments were through the Resource Utilization Groups (RUG-IV) system. Under that system, a patient was considered more complex, and they were sorted in a higher RUGS category if they required more therapy minutes.

Under the Patient Driven Payment Model (PDPM), therapy providers add value to nursing home services through specializations. Therapy providers evolved to meet the needs of specific groups within the nursing home: patients with neurological conditions, orthopedic patients, and those that have had surgery other than orthopedic and joint replacement.

BenCura developed an activities of daily living (ADL) suite at one client building, a specialized program that enrolls patients based on a needs assessment. The therapy provider offers about 18 of these specialty programs in order to better align with the needs of its nursing home clients.

“There’s really a push to prove that value,” said Butler Henderson. “We have to show our partners that we are adding value, because it’s not just about revenue generated by therapy anymore. We show them how we’re adding value through algorithms and matrices and different analytics that we have developed.”

Specializing therapy to align with nursing home needs

Other “ancillary types of conditions” outsourced therapy providers focus on include morbidly obese patients, those that are severely malnourished, patients with psychiatric conditions and those with cognitive deficits, Butler Henderson said.

“We now think differently about how we align with these clinical teams. We look at how we can become the nursing home’s strategic partner, as opposed to being an outside entity that’s just working in a silo and providing therapy,” said Butler Henderson.

Being a better partner often means helping nursing homes maximize revenue they can generate from PDPM, based on the complex patients they’re receiving, she added, proving therapy services can help nursing homes exceed quality measures and reduce survey deficiencies.

“We implement programming specialties that help to address some of these other areas that tend to be pain points for nursing homes,” said Butler Henderson.

BenCura’s therapists receive specialized training for these groups, and therapy managers have separate PDPM meetings where they identify potential service needs.

“There is no one-stop shop in terms of what the needs are, and we make sure that our partners are aware of that. Something that we implement in one building may not be implemented in another,” she said.

Therapy technology and staffing shortages

Ignite, which has in-house therapy services and also contracts with therapy vendors depending on its need, has set itself apart with its robotic technology used by therapists. Ignite is the first skilled nursing group in the country to do this, Thengil said. The company started the program about 8 years ago.

The program has helped Ignite battle staffing shortages, with just one therapist needed per patient. That is an improvement over the old way, which normally would take four therapists to get a patient upright, another to hold the wheelchair closely behind and two more holding a gait belt to help with physical therapy.

Therapy staff shortages aren’t heard of too much compared to nursing shortages, since most operators subcontract therapy, Thengil said. Ignite grappled with a shortage of physical therapists for a couple years now, and the company expects competition for these roles will only increase five years down the road , he said.

For Ignite’s in-house therapy team, Thengil is working to bring therapists over from India and the Philippines, as well as embracing enhanced recruitment techniques for those already on board.

Ignite hasn’t had to utilize agency therapy companies, but it’s been used more widely by the industry to fill in the gaps for physical therapy, occupational therapy and speech, Thengil added.

Cutting-edge tech and forward-thinking teams bring in therapists

All of these outside factors make Ignite’s robotics program all the more integral for its residents in need of therapy, he noted. It’s one of the reasons Ignite’s therapists want to stay with them, and attracts others to join the Ignite team. A forward-thinking perspective on rehabilitation has gone a long way to retain and recruit therapists, he added.

“The type of tools that we have, we only need one therapist. From an efficiency standpoint, this has been tremendous for us. From a safety standpoint, if that patient were to fall or crumble down due to weakness, it is likely that the patient can get hurt and also the therapist,” said Thengil.

The robotics program offers “full fall protection,” where if a resident happens to fall, they will never drop more than a few inches. Not only will the patient remain safe, but the therapist remains safe too, he said.

While the data is still coming in on the effectiveness of the program, Thengil said that he has seen anecdotal evidence it decreases the amount of work-related injuries for staff and patients see a decrease in falls while undergoing therapy.

Other nursing home operators are reaching out to Ignite to learn more about its robotic tech for therapy, he added. Many residents in nursing homes today need more specialized therapy services stemming from the fact that they are frailer and weaker. They require more physical assistance, he said, which led to a need to treat these patients more efficiently rather than traditional methods.

In addition, Ignite wanted to keep up with what they were seeing in hospital inpatient rehabilitation units.

“We pride ourselves on giving our patients choice when it comes to the types of therapy that they have,” added Thengil. “No one tool is going to work for everyone. We know that. So we have created this arsenal of therapy options for our patients to use, one of which is robotic technology.”

While robotics might not be for everyone, let alone virtual reality or simply manual therapy, Ignite wanted to have a “wide array of options,” Thengil said. Covid taught leaders at Ignite that people need to have options in therapy, especially when people were in isolation and weren’t coming in large groups to the gym for physical therapy.

The robotic technology and VR can go bedside for all needed modalities, and equipment is easily accessible, he said.