Finding your post-acute care niche: when traditional skilled care is no longer enough for market survival. Some facility success stories

Nursing Homes, March, 2006 by Sharon Jarchin

Nursing facilities continue to face more challenges than ever before with competition from assisted living centers, dwindling reimbursements, and daily operational obstacles. Today, providing quality skilled nursing care is often not enough to maintain bed-hold and remain profitable. With increased scrutiny from federal and state agencies and easily accessible, but often misleading, state department of health surveys and other government data offered online for families to peruse, many facilities face an uphill battle to retain their image and share of marketplace while remaining fiscally viable. As a result, many facilities are moving away from traditional skilled nursing care and adding clinical specialties to enhance revenue streams and maintain or build census.

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As a nursing facility marketing professional for more than 20 years, I have consistently seen that those facilities that take the leap to find their niche are those that move forward with greater census and profitability. Whether it is short-term rehabilitation, subacute care, bariatric care, hospice, or wound care, nursing facilities are creating and packaging niche areas of expertise to enhance referral sources and case mix and increase census. All facilities, regardless of their present census, should consider specialty clinical programs to remain competitive.

Before embarking on a clinical specialty, however, a facility must examine its strengths, financial resources, physical plant, and staffing. Many facilities do not recognize their own potential in certain areas. I have observed that a professional consultant can often find strengths in a particular area of clinical service that has the potential to be packaged and marketed to a distinct audience. Begin by asking hospital case managers what diagnoses they have difficulty placing to identify services not offered in your area.

What follows are early progress reports from facilities that I have worked with along these lines.

Port Chester Nursing and Rehabilitation Centre, a 160-bed facility in Westchester County, New York (figure 1), had been offering quality nursing care and wanted to stay competitive by expanding its referral base to reach desirable Manhattan hospitals. In a brainstorming session with the owner, administrator, and director of nursing, we strove to identify the facility's clinical strengths in order to build an effective, cohesive, and marketable niche.

Administrator Carol Spedaliere remembers, "We had always had great success with wound care. Our facility had a low incidence of residents developing wounds and had consistent success with incoming hospital wounds. After discussing our potential in this area, we felt we were ready to move to the next step."

The facility began using "wound vac" equipment, trained its staff, and had the director of nursing become certified in wound care. Along with the interdisciplinary team and medical director, staff evaluated and adjusted protocol to accommodate patients with more difficult wounds, specifically by increasing flexibility in wound care product selection depending on individual resident needs. This program was named The Wound Healing Program; brochures were created in both English and Spanish and the marketing began.

The facility received an immediate response from local hospitals that didn't know where to send difficult wounds--including, yes, the desired Manhattan hospitals, which now refer patients with a variety of diagnoses, not just difficult-to-treat wounds, on a regular basis. Spedaliere's advice to others: "Before beginning a niche program, you must have a history of success and know that your staff is up to the challenge."

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Island Nursing and Rehab Center, a 120-bed nonprofit facility in Holtsville, New York (figure 2), decided to keep a short-term rehab census at 25 to 30% of its total population, as it felt it had the physical space and staffing to meet a growing community need. The facility's existing rehabilitation room, in excess of 3,700 square feet, looks more like a professional gym than a nursing home rehab department--and that doesn't include a transfer training car located outside the rehab area or the separate, fully equipped activities-of-daily-living kitchen. The facility recognized the need to hire more staff and added a full-time physical therapist and a COTA (certified occupational therapy assistant), as well as additional RNs and CNAs for the subacute unit, where the facility, to ensure continuity of care, implemented a restorative nursing program for residents discharged from rehab to ensure continued mobility and independence. Staff teamwork is emphasized as essential to this level of service.

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David Fridkin, Island Nursing and Rehab Center's administrator/CEO, says, "Our patients come to us sicker and requiring more acute care because hospitals are discharging them earlier because of their own reimbursement issues. We can handle this level of acute and subacute care and, clearly, at a lesser cost than hospitals can. Our healthcare community knows that when they need rehab, they can count on us."