Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?

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Background

Swing beds are one option for post-acute skilled care in rural communities, and they are more likely to be the only option in the most rural areas.1 These transitional care beds allow a patient to be discharged from an acute hospital stay but remain in the hospital for skilled after care. Skilled nursing facilities (SNFs) are another option for post-acute care when facility-based (rather than home-based) care is needed. Swing beds in small rural hospitals were authorized to allow flexibility in providing post-acute care, particularly in areas where hospital volume is low and options for post-acute care are limited. The North Carolina Rural Health Research Center has undertaken a series of studies to better understand swing bed utilization and cost. Earlier briefs included interviews with hospital administrators about their use of swing beds,2 analysis of trends in swing bed use following reimbursement changes in the Medicare Modernization Act of 2003,1 and examination of the cost of providing swing bed care in Critical Access Hospitals (CAHs).3 In this fourth and final study, we explore the health conditions of patients discharged to facility-based, post-acute care. We used the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 2007 to 2010 to characterize discharges for four groups of patients – patients discharged from 1) CAHs and 2) rural Prospective Payment System (PPS) hospitals to two different types of facility-based post acute care: a) swing beds and b) skilled nursing facilities.

Results

Discharge Destinations from Rural Hospitals Patients discharged to post-acute, facility-based care from rural hospitals represent only 11.7% of all rural hospital discharges (Table 1). For CAHs, 14.1% of patients are discharged to post-acute care with slightly more going to SNFs than to swing beds (8.5% vs 5.6%). For rural PPS hospitals, however, the vast majority of post-acute care discharges are sent to SNFs rather than swing beds (10.4% vs 0.6%).

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