What The Swing Bed Program means for us as a Critical Access Hospital

The purpose of this article is to explain the why behind our Swing Bed Program and how it benefits us as a Critical Access Hospital (CAH). Having an active swing program is a financial benefit to the hospital and a great benefit to our community and patients, especially if the patient wants to stay here, or we can’t find suitable placement. The Swing bed program is also a financial benefit to our employees.

All of our beds are currently licensed to accept swing patients, but please understand our intent is not to take 25 swing patients. Our goal for this year and for 2020 is to maintain an average daily census of 5 in our swing beds. It is our goal to maintain census, financial viability of the organization, and decrease low census days for our staff. The swing bed program gives us an avenue to do this in a cost effective manner.

You might wonder how having swing beds relates to being a CAH. There are several rules for CAH’s and one of those is to maintain an average length of stay (ALOS) of 4 days or less. Our CAH status is dependent on keeping an overall ALOS of less than 4 days and if we go over this, we place our CAH status at risk. Our swing beds allow us to “swing” patients out of their inpatient stay that affects our ALOS and helps us meet the rules for CAH, while recouping a decent revenue stream. It also increases our average daily census to help us keep staff working when our acute census falls short. The swing patient does not affect our ALOS as the rule only applies to acute inpatient admissions.

There are technically two types of patients that are right for this program. Those patients who no longer qualify for acute inpatient care, but need enough continued nursing care (skilled nursing) they would not be safe at home, and those patients who require physical therapy, occupational, and/or speech therapy for strengthening and teaching them to care for themselves. The ideal Swing patient is one who no longer meets inpatient criteria, but is really not safe to discharge. There may be many reasons for this, but the ones that count and allow us to move the patient to swing status are those patients who:

require some rehabilitation after surgery or acute illness
are not sick enough to meet inpatient criteria but are not quite well enough to go home
are end of life patients

The rule is the same for all of these patients in that they must have had at least 3 acute inpatient days. One of the goals we want to meet with our patients is getting them back to their pre-illness baselines. This does not necessarily mean any patient is 100% upon discharge, but it does generally mean the patient or their family will be able to care for them upon their return home. Some of these patients may only require daily therapy for strengthening or they may need more in depth therapy utilizing all or more than one therapy modality. Some of these patients may only require some extra nursing care for a few days and not require services from the therapy department, or a little more intensive wound care.

I hope that this article has answered some of you questions regarding our Swing Bed Program. Please let me know if you have any questions.

Written By Pamela Akin, RN MSN

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