A swing bed program allows hospitals to use their acute care beds for post-acute or skilled nursing care, providing a bridge between intensive hospital treatment and returning home. This designation is primarily utilized by small, rural facilities, particularly Critical Access Hospitals (CAHs), to address the need for rehabilitation and skilled care in communities where standalone Skilled Nursing Facilities (SNFs) may be scarce or nonexistent. The program maximizes local access to necessary recovery services by keeping patients closer to their homes and support systems.
The Purpose and Setting of Swing Beds
These programs were developed to serve rural communities and increase the utilization of hospital beds that might otherwise remain empty. The ability to “swing” a bed means the hospital can change its designation from acute care to skilled nursing care, often without the patient physically moving rooms. This flexibility is permitted under the Social Security Act and is a key feature for Critical Access Hospitals.
Critical Access Hospitals are typically limited to 25 inpatient beds and must maintain an average length of stay for acute patients of 96 hours or less. The swing bed designation allows the hospital to maintain financial viability and a consistent census. This is achieved by converting a bed’s status from acute care to post-acute care when the patient no longer requires intensive services.
Patient Qualification Requirements
To be admitted to a swing bed program, a patient must meet specific criteria established by Medicare for skilled nursing coverage. The primary requirement is the “three-day qualifying hospital stay,” meaning the patient must have been admitted as an inpatient for at least three consecutive calendar days before the swing bed transfer. The day of admission counts toward this requirement, but the day of discharge does not.
Time spent under observation status in the hospital, or in the emergency room prior to admission, does not count toward the three-day inpatient stay. The patient must have an ongoing medical need that requires daily skilled nursing or rehabilitation services that can only be provided in an inpatient setting. Furthermore, the admission to the swing bed must typically occur within 30 days of the qualifying hospital discharge.
Types of Skilled Care Provided
The services provided in a swing bed program are comparable to those offered in a traditional Skilled Nursing Facility. The focus shifts to providing services that facilitate recovery and transition back home. This includes skilled nursing care like complex wound care, where specialized observation and dressing changes are needed.
Patients often receive rehabilitation therapies, which may include physical therapy (PT) to restore mobility and strength. Other skilled services include:
- Skilled nursing care, such as complex wound care requiring specialized observation and dressing changes.
- Rehabilitation therapies, including daily physical therapy (PT) to restore mobility and strength.
- Occupational therapy (OT) to help patients regain the ability to perform daily living activities like dressing and bathing.
- Speech therapy for patients with cognitive or swallowing difficulties following events like a stroke.
- Administration of intravenous (IV) antibiotic therapy or other medications.
- Specialized pain management and the monitoring of conditions such as congestive heart failure.
Understanding Medicare Coverage
Medicare Part A, which covers hospital insurance, is the primary payer for qualified swing bed stays. If all eligibility criteria are met, Medicare Part A typically covers 100% of the cost for the first 20 days of the swing bed stay.
For days 21 through 100, the patient becomes responsible for a daily co-insurance payment or deductible. Coverage ceases entirely after 100 days of care within a single benefit period or when the patient no longer requires daily skilled services. Private insurance policies may also cover swing bed services, but these often require prior authorization and can have different cost-sharing rules.