Nursing Homes Boost Rehab Plans

May 4, 2007
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GRAND RAPIDS — Rehabilitation services in nursing homes are undergoing some changes as the baby-boomer generation crosses into retirement age and as Medicare payments are altered.

Two local nursing homes that have invested in rehabilitation facilities in 2006 and 2007 are Holland Home and PorterHillsRetirementVillage.

"I do think that we are seeing more development, more specialized rehab projects and marketing of those programs," said Beth Ann Brehm, executive director of Porter Hills, which last year separated 24 rooms for rehab patients from the remaining 73 rooms for long-term care and four for hospice. "They come from a hospital setting for a short period of time."

Medicare covers rehab stays in skilled nursing facilities for those age 65 and older for as long as 100 days, under some strict rules, including a hospital stay of at least three days within 30 days prior to the start of inpatient rehab. Patients must be able to handle and benefit from three hours of therapy per day and may face co-pays after 20 days.

The pay-off for nursing homes is the level of Medicare reimbursements for skilled nursing care and therapy, which help to offset the lower Medicaid payments they receive for indigent long-term care. For a highly complicated patient with high rehab needs, the payment can stretch to more than $200 per day, according to the federal Medicare Payment Advisory Commission (MedPAC), which advises Congress.   

"Certainly we get better reimbursements from Medicare for those services," Brehm said. "That's one of the drivers, but certainly there is a need in the community. Our hospital liaison found that many need this type of service, so it's in response to a demand we've identified. And we've been successful in keeping rehab beds full."

A March MedPAC report states that across the nation, the six categories of highest-need rehab patients — out of a total 53 payment categories — accounted for 42 percent of patient-days in skilled nursing facilities in 2005, which was 14 percent higher than in 2002. While nursing-related services still consume the biggest percentage of Medicare dollars for skilled nursing facilities, the proportion of payment for therapy services is growing, the report noted.

On average, the report stated, Medicare payments represent about 21 percent of revenue for free-standing skilled nursing facilities across the country, even though those patients comprise a smaller part of a nursing home's business. Nursing home-based rehab typically includes physical therapy, occupational therapy, speech therapy and recreation therapy.

Michelle Chapie, Porter Hills Rehab manager, said the company decided to revamp its rehab area in anticipation of demand in the wake of a Medicare rule change that is expected to prevent some patients from receiving care at inpatient rehabilitation facilities such as MaryFreeBedHospital. The Medicare change is expected to effect orthopedic patients in particular, according to MedCAP, which reported in March that major joint replacements such as knee and hip fell from 24.6 percent of patients at inpatient rehabilitation facilities in 2004 to 18.4 percent in 2006.

"We were initially trying to address those and accommodate those that wouldn't be allowed to stay in a rehab hospital, and tried to provide an environment that would accommodate them," Chapie said. "We're anticipating being able to capture some of that overflow."

Holland Home operates Breton Manor, Fulton Manor and Raybrook Manor. Maureen Myers, business development manager for Rehab Dimensions, a subsidiary of Holland Home, said the company is about to expand the rehab area at Raybrook. The plans include direct outside access to serve outpatient rehab patients, as well, she said.

"There was a big surge in it (rehab) in the mid-1990s, basically when people started realizing that people coming out the hospital needed services, and that Medicaid Part A was available and useful for that," Myers said. "Basically, you can't have a nursing home any more without it. People don't come to a nursing home and just stay in a nursing home. A large portion comes in for short-term care. There's a continual revolving door with that segment of the population."

National reports have indicated some nursing homes are turning rehab rooms into posh suites complete with aromatherapy and flat screen TVs. Local plans are not as lavish, but some amenities are showing up.

Porter Hills Rehab, Chapie said, is currently renovating its semi-private rehab rooms with carpeting, paint, furniture and new televisions. "We want to make it more of a desirable stay, especially for younger people who have expectations of the setting they would be in," she said.

Porter Hills Rehab is a joint venture between PorterHills and Rehab Professionals. Rehab Professionals is jointly owned by MaryFreeBedHospital, Saint Mary's Health Care and Agility Health, Chapie said.

At the TenderCare facility, opening in Wyoming later this month, all 80 private patient rooms are available as rehab beds, said Community Relations Representative Karen Peters. And they all have wireless Internet access, she added, "so if I'm 54 years old and in an auto accident and I need rehab for two weeks, I don't have to worry about being put in a room with an 80-year-old with a breathing apparatus. The whole building is wireless, so they bring their laptops and stay in touch with e-mail and work."    

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