Why Use Swing Beds? Conversations with Hospital Administrators and Staff

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Overview

Swing beds are one option for post-acute skilled care in rural communities; they are more likely to be the only option in the most rural areas.1 How are they being used? What do they mean for the hospital and the community? We explored these issues with hospital staff to inform our analytic studies on swing bed trends1 , costs2 , and clinical uses. We used Medicare Hospital Cost Reports to identify hospitals with swing beds, and interviewed the CEO or his/her designee (often the swing bed coordinator) in 23 randomly selected hospitals (52% response). Semi-structured interview protocols were used with open-ended questions. Hospitals were located in all four US Census regions and included both Critical Access Hospitals (66%) and those paid under the Prospective Payment System (33%). Some hospitals also had skilled nursing facilities (SNFs). The study was approved by the Institutional Review Board (IRB), and interviews took place in late 2010.

Key findings

Role of Swing Beds in Patient Care

  • Critical Access Hospital (CAH) administrators and staff reported using swing beds to care for patients with health problems typically seen in their elderly patient population. The most commonly reported need was for physical and occupational therapy for orthopedic patients or for patients who need strengthening following their hospital stay. Patients requiring wound care and/or intravenous antibiotics were also common among the swing bed population. Some respondents reported using their swing beds for hospice or end-of-life care.
  • CAH respondents reported a wider range of health problems among their swing beds patients than was reported by Prospective Payment System (PPS) respondents. Health problems treated in swing beds also varied by the availability of providers or other care in the community, e.g., availability of an orthopedic surgeon or availability of skilled nursing care.
  • Some respondents noted that “medically complex” patients were more likely to be cared for in their swing beds than in their local SNFs. A patient needing intravenous antibiotics is one example of a medically complex patient that might be cared for in a swing bed.
  • Some respondents, especially those at PPS hospitals, noted that their hospital’s philosophy of care was to admit patients to swing beds only if a short-term stay, i.e., one or two weeks, was anticipated and to look for other options when longer term care was needed