Subacute Rehabilitation at Home: Potential Solve for Skilled Nursing Needs
UMass Memorial Health recently began offering the Subacute Rehabilitation at Home program to its patients. Also known as SARAH, the program provides subacute-level care, previously only delivered in subacute nursing facilities, to patients in the comfort of their homes. It is part of a randomized clinical trial, known as SNF at Home, launched by UMass Chan Medical School in response to the ongoing shortage of skilled nursing facility beds.
Patients receive comprehensive care based on their needs, including the services of a home health aide; physical, occupational, and speech-language pathology therapy; medication management; home infusion; physician visits; case management; and social work consultation. Care is delivered in person and virtually, as needed, with vital signs monitored remotely and uploaded directly into Epic.
“Patients are being provided with simplified tablets to communicate with caregivers,” said hospitalist Wendy Mitchell, MD, Medical Director of Digital Programs and Strategy and Clinical Lead for the study at the UMass Memorial Medical Center . “They will also have access to a smartwatch or loaner smartphone as needed.”
Subacute Rehab at Home began enrolling patients in late August and builds on the success of UMass Memorial’s Hospital at Home (HaH) and Healthy at Home. Those programs use app-based consumer technology and comprehensive virtual disease management to improve quality of life and achieve better health outcomes for chronic obstructive pulmonary disease patients.
“Hospital at Home proved that it is possible to take excellent care of patients with serious illness in the home, which is where patients prefer to be,” said Dr. Mitchell. “Patients usually do better when they receive care at home. They tend to be more ambulatory than in a facility, aiding recovery, and are generally happier.”
Subacute Care at Home utilizes the infrastructure already in place for HaH, with that program’s nurses providing direct care and its command center handling logistics.
The trial's primary outcome will be measuring the 30-day rehospitalization rate, said Apurv Soni , MD, PhD, Co-Director of the Program in Digital Medicine at UMass Chan Medical School. Researchers will also assess patients’ functional status and satisfaction and compare the costs of providing skilled nursing facility care in a patient’s home with those of inpatient skilled nursing facility care. The impact of home-based versus inpatient care on patients’ families or other caregivers will also be measured.
The study is supported by a $6.5 million grant from the Massachusetts Executive Office of Health and Human Services. It plans to enroll 650 patients eligible for inpatient-level skilled nursing care following acute hospitalization across the two sites.
The trial is open to any patient age 18 or older admitted to an inpatient unit who requires skilled nursing level post-acute care. Patients receiving home health care and requiring a higher level of care are also eligible. Enrollees must pass a home readiness assessment.