All post-acute settings are not created equal.1 The growing rate of skilled nursing facility (SNF) closures has only reinforced this gap in care quality, leaving patients and hospitals straining to find care settings equipped and available to meet their unique needs.
One setting that has weathered the storm of shifting regulatory changes, population health transitions, a global pandemic, and the rise in medically complex patients: Inpatient rehabilitation.
2023 Performance: SNF vs. IRF2
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- Inpatient rehabilitation operations maintain a 70% discharge to the community rate, 37% higher than SNFs on average.
- SNF average length of stay (ALOS) was 2X higher than IRF ALOS.
- SNF 90-day readmission rate was 500,000 patients higher than IRF rates.
- SNF 30- and 90-day mortality were nearly 2X IRF mortality.
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But what enables IRFs to produce these exceptional outcomes?
Comparing Care Settings: IRF vs. SNF
License/Certification
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IRF |
Certified as acute level of care. Licensed as freestanding inpatient rehab hospital/distinct rehab unit within a host hospital. |
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SNF |
Licensed as a SNF. |
Physician Involvement
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IRF |
Daily physician visits. |
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SNF |
Required physician visit during first 30 days; one visit every following 60 days. |
Nursing
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IRF |
Receive specialized training in rehab nursing, pain management & medication, skin integrity and self-care training. Provide 24-hour nursing care; intervention, assessment and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment. Average nursing hours per patient day (NHPPD): 6+ |
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SNF |
Must have at least one RN for eight straight hours/day, seven days/week, and either an RN or LPN/LVN on duty 24/7; intervention, assessment and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment. Average NHPPD: 4.1 |
Rehab Therapy and Admission Criteria
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IRF |
Available to patients requiring intensive rehabilitation therapy (minimum of two therapy disciplines). Patients participate in therapy three hours/day, five days/week or 15 hours over seven days. |
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SNF |
Patients must have a qualifying hospital stay for at least three patient days and a physician determines the patient requires daily skilled care from nursing or therapy. PT/OT/ST available with a nondisciplinary approach to care. Level of participation, type and amount of therapy varies based on medical needs and functional potential. |
Team Treatment
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IRF |
Interdisciplinary approach between physician, therapy team, social work and nursing to facilitate recovery. Physician-led weekly team conferences required. |
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SNF |
Interdisciplinary approach between therapy and nursing to facilitate recovery. |
Ancillary Services
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IRF |
Services on site: pharmacy, lab, radiology, and all other hospital services. |
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SNF |
Services available, but not on site: pharmacy consultant, lab, radiology. |
Patient Characteristics
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IRF |
Medically complex patient demonstrates sufficient potential to participate in rehab and make significant functional and/or cognitive gains with the goal to return home or a community-based setting. Common admission patient description:
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SNF |
Patient demonstrates a potential for general health improvement. Common admission patient description:
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Read our full white paper, Achieving Optimal Patient and Hospital Outcomes: Why Care Settings Matter.
References:
- Nickels, T. (2020, June 24). AHA Letter on Resetting the IMPACT Act in Next COVID-19 Relief Package: Retrieved June 29, 2020, from https:// www.aha.org/lettercomment/2020-06-24-aha-letter-resetting-impact-act-next-covid-19-relief-package
- Skilled nursing facility (SNF) quality reporting program (QRP) public reporting. CMS.gov. (2023). https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/nursinghomequalityinits/skilled-nursing-facility-quality-reporting-program/snf-quality-reporting-program-public-reporting
