Skilled Nursing Culture Change Indicates Diversified Model with Rehab Emphasis

The skilled nursing industry is being swept by culture change, but despite relative uncertainty tied to fluctuating Medicare reimbursements and constrained Medicaid budgets, nursing homes aren’t becoming obsolete by any means; rather, care models are changing to reflect what consumers expect—and what healthcare reform demands.

The traditional model of long-term care nursing homes is getting squeezed out, to some extent, in favor of less institutional settings.

More states are pursuing initiatives to place eligible people in less expensive settings, such as assisted living or other residential care communities. And with hospitals facing Medicare reimbursement penalties for avoidable readmissions that have been deemed excessive, the role of short-term skilled nursing facilities offering rehabilitation services is getting significantly larger.


The spotlight is on hospitals and what happens to their patients upon discharge. Similarly, post-acute care providers are also under more scrutiny, because hospitals want to ensure that the facilities to which they discharge patients can provide quality care and prevent readmissions.

Skilled nursing facilities can play an integral role in the post-acute care continuum, but in order to do so, some of them have to evolve. 

“Nursing homes are relevant and will remain relevant as a cost-effective substitute for clinical care, and a cost-effective setting in which to do intensive rehabilitation,” said Dan Mendelson, the CEO and founder of Avalere Health, a business strategy and public policy firm focused on the nation’s healthcare problems, in a previous interview with SHN.


“The very-long stay nursing homes, that are primarily Medicaid-dependent,” he continues, “are going to be squeezed out of business, because they won’t have any subsidy. A more intensive style of nursing home care will emerge [and will be] enduring, because it’s a cost-effective way to provide transitional care.”

Going forward, he says, the nursing home industry will need to prove its ability to be a partner in the healthcare system by providing effective care. The industry also needs to appeal to consumers, and what consumers overwhelmingly want is individualized, person-centered care in non-institutional settings. 

Skilled nursing and rehabilitation are clinical by nature, but the facilities providing these services don’t necessarily have to reflect that in terms of design and amenities. Some architects and designers are seeing long-term care providers looking to revamp their models to more closely match current trends.

Within the skilled nursing projects Austin, Tex.-based Pi Architects is doing, there are two main pushes, says the firm’s president, Greg Hunteman, who also leads the senior living design team. The movements are toward the “small house” model of long-term care facilities, he says, along with “a whole lot more” rehabilitation. 

While his firm has been designing household-model skilled nursing communities for nonprofit clients for quite some time now, says Hunteman, it’s a newer trend on the for-profit side. 

“It gives them flexibility as far as treating each house, whether it’s long-term care, Medicare or Medicaid, or rehabilitation,” he says. Offering specialized rehabilitation services is becoming more common, and new designs are reflecting that. 

“The rehab suite itself is bigger, and there are more specialized amenities,” says the architect, adding that providers are interested in creating a rehab unit that can specialize and cater to the life of a resident who’s there on a short-term basis.

One rehabilitation and healthcare facility owner/operator has just broken ground on an upscale senior care facility in Rockwall, Tex., that will offer both short-term skilled nursing and long-term care. SCC Health Care Group’s Broadmoor Medical Resort, scheduled to open in early 2013, will feature hotel-style recovery suites with resort-like amenities and will provide a spectrum of rehabilitation services and therapies.

“We want to move away from the traditional, sterile health care climate,” said Don Miller, managing partner of SCC Healthcare Group, in a statement about the new project. “Our medical resort will not have the feel of a rehabilitation center or skilled nursing community. It will feel more like an upscale experience in a hotel.”

But converting existing, more traditional nursing homes, or breaking ground on new facilities with diversified services, isn’t a universal requirement.

“Each individual prototype depends on the market,” says Hunteman.

Written by Alyssa Gerace

Coming soon: Senior Housing News is taking a closer look into Genesis Healthcare’s PowerBack short-term rehabilitation model and Greystone Healthcare Management Corp.’s recently-completed “health club”—a short-term rehabilitation facility located in The Villages, Fla. 

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