Swing-bed program opens options for rural elderly

Medicare regulations restricting the provision of long-term care in acute care settings imposed a special hardship on care providers and patients in rural communities, where nursing homes are few and hospital beds go unoccupied, resulting in lower revenues and operating margins for hospitals. As a result, in 1973 Medicare began an experiment in Utah to permit the use of hospital beds for both acute and long-term care. The program was premised on the fact that elderly patients from rural communities had to travel to distant urban areas to receive long-term care, especially Medicare-covered care at skilled nursing facilities. The success of the experimental program led to enabling legislation for a national rural swing-bed program. By July 1987, 1,056 rural communities were participating in the program. Generally speaking, long-term care patients in swing beds stay an average of 20 days, significantly less time than the several hundred days patients stay in nursing homes. The typical swing-bed patient is a subacute care patient who usually is transferred from an acute care setting, with such conditions as stroke, recovery from surgery, hip fracture, and cardiac problems.