Offering intensive services and remote monitoring technology in the home can work as an alternative \u2014 especially in rural areas, where nursing homes are closing at a faster rate<\/a> than in cities and patients\u2019 relatives often must travel far to visit. For patients of the Marshfield Clinic Health System who live in rural parts of Wisconsin, the clinic\u2019s six-year-old SNF-at-home program is often the only option, said Swetha Gudibanda<\/a>, medical director of the hospital-at-home program.<\/p>\n \u201cThis is going to be the future of medicine,\u201d Gudibanda said.<\/p>\n But the concept is new, an outgrowth of hospital-at-home services expanded by a covid-19 pandemic-inspired Medicare waiver. SNF-at-home care remains uncommon, lost in a fiscal and regulatory netherworld. No federal standards spell out how to run these programs, which patients should qualify, or what services to offer. No reimbursement mechanism exists, so fee-for-service Medicare and most insurance companies don\u2019t cover such care at home.<\/p>\n The programs have emerged only at a few hospital systems with their own insurance companies (like the Marshfield Clinic) or those that arrange for \u201cbundled payments,\u201d in which providers receive a set fee to manage an episode of care, as can occur with Medicare Advantage plans.<\/p>\n In Durocher\u2019s case, the care was available \u2014 at no cost to him or other patients \u2014 only through the clinical trial, funded by a grant from the state Medicaid program. State health officials supported two simultaneous studies at UMass and Mass General Brigham hoping to reduce costs, improve quality of care, and, crucially, make it easier to transition patients out of the hospital.<\/p>\n The American Health Care Association, the trade group representing more than 15,000 long-term and post-acute care providers, calls \u201cSNF at home\u201d a misnomer because, by law, such services must be provided in an institution and meet detailed requirements.\u00a0And the association points out that skilled nursing facilities provide services and socialization that can never be replicated at home, such as daily activity programs, religious services, and access to social workers.<\/p>\n But patients at home tend to get up and move around more than those in a facility, speeding their recovery, said Wendy Mitchell<\/a>, medical director of the UMass Chan clinical trial. Also, therapy is tailored to their home environment, teaching patients to navigate the exact stairs and bathrooms they\u2019ll eventually use on their own.<\/p>\n A quarter of people who go into nursing homes suffer an \u201cadverse event,\u201d such as infection or bed sore, said David Levine<\/a>, clinical director for research for Mass General Brigham\u2019s Healthcare at Home program and leader of its study. \u201cWe cause a lot of harm in facility-based care,\u201d he said.<\/p>\n By contrast, in 2024, not one patient in the Rehabilitation Care at Home program of Nashville-based Contessa Health developed a bed sore and only 0.3% came down with an infection while at home, according to internal company data. Contessa delivers care in the home through partnerships with five health systems, including Mount Sinai Health System in New York City, the Allegheny Health Network in Pennsylvania, and Wisconsin\u2019s Marshfield Clinic.<\/p>\n Contessa\u2019s program, which has been providing in-home post-hospital rehabilitation since 2019, depends on help from unpaid family caregivers. \u201cAlmost universally, our patients have somebody living with them,\u201d said Robert Moskowitz<\/a>, Contessa\u2019s acting president and chief medical officer.<\/p>\n The two Massachusetts-based studies, however, do enroll patients who live alone. In the UMass trial, an overnight home health aide can stay for a day or two if needed. And while alone, patients \u201chave a single-button access to a live person from our command center,\u201d said Apurv Soni<\/a>, an assistant professor of medicine at UMass Chan and the leader of its study.<\/p>\n But SNF at home is not without hazards, and choosing the right patients to enroll is critical. The UMass research team learned an important lesson when a patient with mild dementia became alarmed by unfamiliar caregivers coming to her home. She was readmitted to the hospital, according to Mitchell.<\/p>\n The Mass General Brigham study relies heavily on technology intended to reduce the need for highly skilled staff. A nurse and physician each conducts an in-home visit, but the patient is otherwise monitored remotely. Medical assistants visit the home to gather data with a portable ultrasound, portable X-ray, and a device that can analyze blood tests on-site. A machine the size of a toaster oven dispenses medication, with a robotic arm that drops the pills into a dispensing unit.<\/p>\n The UMass trial, the one Durocher enrolled in, instead chose a \u201clight touch\u201d with technology, using only a few devices, Soni said.<\/p>\n The day Durocher went home, he said, a nurse met him there and showed him how to use a wireless blood pressure cuff, wireless pulse oximeter, and digital tablet that would transmit his vital signs twice a day. Over the next few days, he said, nurses came by to take blood samples and check on him. Physical and occupational therapists provided several hours of treatment every day, and a home health aide came a few hours a day. To his delight, the program even sent three meals a day.<\/p>\n Durocher learned to use the walker and how to get up the stairs to his bedroom with one crutch and support from his wife. After just one week, he transitioned to less-frequent, in-home physical therapy, covered by his insurance.<\/p>\n \u201cThe recovery is amazing because you\u2019re in your own setting,\u201d Durocher said. \u201cTo be relegated to a chair and a walker, and at first somebody helping you get up, or into bed, showering you \u2014 it\u2019s very humbling. But it\u2019s comfortable. It\u2019s home, right?\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/03\/SNF-at-Home-\u2013-Marc-and-Jeanne-Durocher-01.jpg\")
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