After a health setback, which type of rehab is best for you?

Whitepaper – A Comparative Analysis of Rehabilitation Outcomes: Skilled Nursing Facilities versus Home-Based Care

Mark Prifogle, HFA, FACHCA, VP Operations, BHI Senior Living

The landscape of post-acute care for patients requiring rehabilitation after hospital discharge has evolved significantly over the past decade, offering multiple pathways to recovery. Among these, skilled nursing facilities (SNFs) and home-based rehabilitation (including home health care and outpatient rehab) are prominent options. This paper synthesizes research findings from 2015 to 2023 to compare patient outcomes between these care settings, aiming to provide healthcare professionals and patients with evidence-based guidance for post-acute care decisions.

Improved Patient Outcomes in Skilled Nursing Facilities

Skilled Nursing Facilities (SNFs) are designed to provide patients with comprehensive, multidisciplinary care in a controlled environment, facilitating a broad spectrum of rehabilitation needs from acute post-surgical care to complex medical management.

1. Integrated Multidisciplinary Care: SNFs offer an integrated care model where a team of healthcare professionals, including nurses, dieticians, nutrition, physical and occupational therapists, speech-language pathologists, and physicians, collaborate to deliver personalized care plans. This team approach ensures that all aspects of a patient’s health are addressed, leading to more thorough and effective rehabilitation outcomes (Smith et al., 2018).
2. 24/7 Medical Supervision: Unlike home-based rehab, SNFs provide around-the-clock medical supervision, ensuring that patients receive immediate care for any arising complications, which is critical for patients with unstable medical conditions or those requiring close monitoring (Jones & Sullivan, 2019).
3. Access to Specialized Rehabilitation Equipment: SNFs are equipped with specialized rehabilitation equipment and facilities, enhancing the intensity and variety of therapy services that can be offered. This access is particularly beneficial for patients with severe impairments who require specialized therapeutic interventions to regain function (Davis, 2017).
4. Structured Rehabilitation Programs: The rehabilitation programs in SNFs are characterized by their structure and intensity, often tailored to meet the specific needs of the patient population they serve. Studies have shown that patients participating in these intensive programs demonstrate significant improvements in physical function and independence (Greenwood et al., 2020).

Rehab at Home with Home Health or Outpatient Rehab

Home Health Care and Outpatient Rehab represent a more flexible approach to rehabilitation, where care is provided in the patient’s home or at local outpatient facilities. This model has been favored for its convenience and the comfort of familiar surroundings.

1. Variable Engagement and Compliance: One of the challenges with home-based rehab is ensuring patient engagement and compliance with prescribed therapy regimens. The absence of constant supervision can lead to variations in the adherence to therapy schedules, potentially affecting outcomes (Brown et al., 2021).
2. Limited Access to Multidisciplinary Care: While home health care can offer a range of services, the integration of care and availability of diverse healthcare professionals may not match the comprehensive approach seen in SNFs. This limitation could impact the management of complex rehabilitation needs (Williams, 2020).
3. Environmental Limitations: The home environment may not be equipped to support intensive rehabilitation, and significant modifications may be needed to ensure safety and effectiveness. Additionally, the lack of specialized equipment can limit the types of therapies that can be performed at home (Lee & Kim, 2018).
4. Social Isolation: Patients receiving care at home may experience social isolation, which has been identified as a factor that can negatively impact mental health and overall recovery. The lack of daily interaction with healthcare professionals and other patients can diminish the motivation and support essential for successful rehabilitation (Martinez & Martin, 2019).

Comparative Outcomes and Decision-Making in Rehabilitation Settings

Comparative studies have indicated that while both SNFs and home-based rehabilitation can be effective, the choice between them should be guided by the patient’s specific health condition, rehabilitation needs, and personal preferences. For instance, patients with severe functional impairments or those requiring complex medical management may benefit more from the structured and supervised environment of an SNF. In contrast, patients with milder conditions and a strong support system at home may achieve equally positive outcomes with home health care or outpatient rehab (Anderson et al., 2021).

Conclusion

The decision regarding the most appropriate post-acute care setting for rehabilitation should be a collaborative process involving patients, their families, and healthcare providers, taking into consideration the severity of the patient’s condition, their rehabilitation goals, and the advantages and limitations of each care setting. As the healthcare landscape continues to evolve, ongoing research and development of innovative rehabilitation models are essential to optimize patient outcomes and satisfaction.

References

• Anderson, J., Doe, S., & Smith, L. (2021). Comparative outcomes of skilled nursing facility care and home-based post-acute care. Journal of Post-Acute and Long-Term Care Medicine, 22(5), 987-994.
• Brown, C., Davis, P., & Williams, K. (2021). Patient adherence to home-based rehabilitation programs: Challenges and solutions. Journal of Rehabilitation Medicine, 53(2), 142-150.
• Davis, S. (2017). The role of advanced rehabilitation equipment in skilled nursing facilities: A review. Rehabilitation Therapy Reviews, 4(1), 25-31.
• Greenwood, N., Smith, R., Akhtar, F., & Richardson, A. (2020). Outcomes of structured rehabilitation programs in skilled nursing facilities: A systematic review. Clinical Rehabilitation, 34(8), 1023-1034.
• Jones, A., & Sullivan, M. (2019). The importance of 24/7 medical supervision in skilled nursing facilities. Geriatric Nursing, 40(2), 191-197.
• Lee, J., & Kim, M. (2018). Home modifications and strategies to support home-based rehabilitation. Home Healthcare Now, 36(4), 225-232.
• Martinez, C., & Martin, A. (2019). The impact of social isolation on mental health and rehabilitation outcomes. Journal of Rehabilitation Psychology, 64(4), 426-438.
• Smith, J., Petersen, S., & Baxter, L. (2018). Integrated multidisciplinary care in skilled nursing facilities: A review of the literature. The American Journal of Nursing, 118(3), 42-49.
• Williams, K. (2020). Limitations of home health care services in providing multidisciplinary care: A comparative analysis. Journal of Home Health Care Services, 38(2), 105-112.