A swing bed is a hospital bed designated for two types of care: acute medical care or post-hospital skilled nursing care. This dual-purpose designation allows the bed to “swing” its function based on a patient’s changing medical needs. The concept is common in smaller, often rural, hospitals, especially Critical Access Hospitals (CAHs), where dedicated Skilled Nursing Facilities (SNFs) may not be readily available. This program provides a transitional step for patients who are medically stable but not yet strong enough to return home following a serious illness, injury, or surgery.
The Purpose of a Swing Bed Designation
The primary reason for the swing bed designation is to address the logistical challenges faced by smaller, rural hospitals in providing a complete continuum of care. Transferring a patient who needs rehabilitation or extended recovery to a distant Skilled Nursing Facility can be disruptive and stressful for the patient and their family. The swing bed program was established by the Social Security Act to permit these hospitals to use their existing inpatient capacity for post-acute care.
Operational flexibility is a significant benefit, allowing the hospital to utilize its beds more efficiently by switching their status from acute to post-acute recovery as patient census fluctuates. This system helps the hospital maintain financial viability. Remaining in the same facility also offers patients the comfort of familiarity, continued care from the same staff, and proximity to their local support network.
Patient Requirements for Admittance
For a patient to be admitted into a swing bed program, specific prerequisites must be met, especially for Medicare coverage, which is the primary payer. The most fundamental requirement is a “qualifying hospital stay,” mandating that the patient must have been admitted as an inpatient in an acute care hospital for a minimum of three consecutive days. This three-day stay must immediately precede the swing bed admission or occur within 30 days of it.
Beyond the qualifying stay, the patient must demonstrate a continuing need for daily skilled nursing care or skilled rehabilitation services that can only be provided in an inpatient setting. Skilled nursing services include specialized treatments like intravenous (IV) medication administration, complex wound care, or management of a tracheostomy. For rehabilitation, the requirement is often met if the patient needs physical, occupational, or speech therapy at least five days a week. A physician must certify that this level of skilled care is medically necessary for the patient’s recovery.
Services Available During the Stay
The care provided in a swing bed focuses intensely on recovery and regaining independence, offering a different emphasis than the acute, life-saving focus of the initial hospital stay. A core component of the services is rehabilitation, which includes physical therapy (PT) to restore mobility and strength, occupational therapy (OT) to relearn daily living activities, and speech therapy to address swallowing or communication difficulties. These therapies are typically provided daily with specific, measurable goals for improvement and discharge.
Skilled nursing care is delivered around the clock by registered nurses who manage treatments too complex for a non-skilled setting. This includes administering long-term intravenous antibiotics, performing advanced dressing changes for severe wounds, and managing pain. Many programs also offer respiratory therapy, nutritional services, and case management to coordinate the patient’s recovery plan and discharge.
How Swing Bed Care is Funded
For the majority of patients, swing bed services are funded through Medicare Part A, which covers inpatient hospital and Skilled Nursing Facility care. The coverage is structured similarly to that of a stand-alone SNF, with a benefit period that can cover up to 100 days of care. For the first 20 days of the swing bed stay, Medicare Part A covers the cost of care in full, provided the patient meets all skilled care requirements.
After the initial 20 days, a daily co-insurance payment is required from the patient for days 21 through 100 of the benefit period. This co-insurance amount is set annually by Medicare and can be covered by a secondary insurance, such as a Medigap policy. If a patient exhausts their 100 days of Medicare coverage or does not meet the skilled care requirement, they become financially responsible for the entire daily cost. While Medicare is the primary funding source, some private insurance plans and Medicare Advantage plans may also cover the service.