Mass General Brigham has been awarded a $4.6 million grant to examine the delivery of short-term rehab care at home as an alternative to skilled nursing facilities (SNFs).
The funds come from the Massachusetts Executive Office of Health and Human Services (EOHHS).
In the U.S., 40% of older adults leaving the hospitals need some form of post-hospital care. Roughly half of them get this care in an inpatient SNF, according to data from The Medicare Payment Advisory Commission (MedPAC).
“Our skilled nursing facility and post-acute care institutional settings do not work as we all would like them to,” Dr. David Levine, clinical director for research and development at Mass General Brigham’s Healthcare at Home, told Home Health Care News. “A quarter of people in America who get care in a post-acute facility will have an adverse event, for example. Some studies put it even higher than that. We don’t want to send people to a place where 25% of the time something wrong is happening. We’re looking for a better way, and rehab at home is a possible way, but needs to be tested.”
Levine is the principal investigator of the study Mass General Brigham will be conducting.
Mass General Brigham will examine the delivery of short-term rehab care at home by conducting a randomized control trial. Half the patients in the study will enter a SNF, and the other half will go home with Mass General Brigham’s specialized rehab-at-home team.
The patients that are part of the second group will see a nurse, certified nurse assistant, physician and home health aide as part of their admission into the study. Their care plan will also include daily remote physician and in-home certified nurse assistant visits, as well as physical, occupational and speech therapies, if needed.
Plus, they have access to 24-hour, in-home response from mobile integrated health paramedics.
The study will include 300 patients from five acute care hospitals across Boston.
“It’s the first opportunity ever, in the country, to really demonstrate this care model in a very robust way — to see if it’s helpful for patients and caregivers and clinicians,” Levine said.
If the results of the study are positive, it could lead to creation of a more permanent rehab care at home program at Mass General Brigham.
Levine pointed to the evolution of the hospital-at-home model, seeing it as an example of how the rehab care at home program could grow in the near-term future.
“The home hospital movement is an area I’ve been working in for over a decade, and we did the first randomized control trial of home hospital in the United States,” he said. “That has led to things like the Acute Hospital Care at Home waiver. My hope is that with a robust evidence base, we’ll be able to inform policy and then create a payment mechanism for rehab at home. If there’s a payment mechanism, it would only make sense for places like Mass General Brigham, and any place that delivers acute care.”
Ultimately, the study builds on the work that Mass General Brigham is already doing in the home.
“I think we have an extremely robust health care at home chassis at MGB,” Levine said. “We have one of the largest home hospital programs in the country. We have a very large home health team and program. We have a home-based palliative care program, and rehab at home is one of our next interests, as well as expanding our current offerings. Delivering care at home is a huge priority at MGB, and I think we see that reflected in the size of our programs, as well as the creativity and innovation behind them.”
