How a Cheektowaga nursing home hopes to end ‘yo-yo effect’ of repeat hospital visits

March 20--The new complex medical care unit at Garden Gate Health Care Facility in Cheektowaga looks more like a hospital cardiac wing than a nursing home.

With its high-tech features, physician coverage and nurse-to-patient ratio, the unit reflects an emerging trend.

The idea: provide hospital-level services in a skilled nursing facility so it can serve hospital patients with more complex conditions, allowing them to rehab at lower costs while also reducing the risk of rehospitalization.

"Families and patients are dissatisfied with the yo-yo effect of going from hospital to nursing home and back to the hospital. We talk to people about treating them in place. We can do that here in the subacute space. The nursing home, with medical backup, can function like a mini-hospital," said Dr. Ray Ogra, co-medical director of the unit.

Hospitals and nursing homes face pressure from the government and insurers to take on the revolving door of readmissions and high emergency room use. Today, more than one in five Medicare patients return to the hospital within a month, often for avoidable reasons, at great cost to the health care system.

The Garden Gate facility is trying a new approach that officials hope will keep patients from returning to the hospital and save money, too.

The 18-bed unit at Garden Gate uses a remote monitoring system with portable sensors. It has a bulked-up nursing staff, with one registered nurse for every six patients. It has telemedicine capabilities that allow staff to consult with physicians and other experts by phone. And it works with a team of doctors in a partnership with Buffalo Medical Group, one of the area's largest multi-specialty practices, to oversee the program.

The monitoring system is similar to one trademarked as Telistat that was developed by VestraCare, a Long Island-based nursing home company that, in 2016, bought a 20 percent stake in McGuire Group's nursing home business. VestraCare piloted the system at its Kingston nursing home and reported that hospital readmissions declined to less than 5 percent.

Ogra, co-director of inpatient and subacute medical services at the medical group, said there used to be a high degree of suspicion in the medical community about the ability of a nursing home to offer more intensive care. That's not the case anymore, he said, with the right technology in place and a commitment from the skilled nursing facility.

"Hospitals are under increasing pressure to discharge patients in three to five days. The subacute space is a great place to offer this care. We can also handle the patient in an outpatient setting who needs to be monitored more closely," Ogra said.

Telistat received a $4.5 million grant in the 2016-17 state budget to evaluate the technology, which it calls a restorative care unit, and make recommendations for use statewide.

The McGuire Group installed Telistat at its Long Island skilled nursing facility in Brookhaven using grant money. Garden Gate funded its own similar system and, based on the experience here, the McGuire Group will consider similar units at its four other facilities in Western New York and expansion to include other conditions, said F. James McGuire, chief executive officer.

Other skilled nursing facilities provide rehabilitation care to cardiac patients discharged from a hospital. But McGuire said the unit, with its enhanced nurse and physician support, will give hospitals and primary care doctors the comfort level needed to refer more complex patients they ordinarily would not send, he said.

"You need to maintain a high level of sophistication to care for these patients," McGuire said. "We can take more appropriate clinical action to identify issues and keep people through their rehab."

Reimbursement for patients in the unit is not higher than usual, according to McGuire. He said the company is hopeful payers will consider increasing rates, assuming the unit proves its value by shortening hospital stays for patients with heart-related problems and reducing readmissions from the nursing home.

The McGuire Group sold its nursing home properties about seven years ago but holds the operating certificates, acting as an administrative services company that provides the main supportive services. Each facility, which also provides long-term care, is its own operator under a lease agreement with the Sabra Health Care real estate investment trust.

Buffalo Medical Group had sought a partner to expand its work in subacute care at skilled nursing facilities, Ogra said.

"For us, subacute care bridges the gap between outpatient and inpatient services," he said.

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