Inpatient beds that can move from acute care to skilled nursing, as needed—known as swing beds—help patients transition from hospital to home. They can also help rural hospitals  transition from struggling to success.

This is particularly true for Critical Access Hospitals (CAHs), which can receive higher reimbursement rates from Medicare for swing bed services compared to larger Prospective Payment System (PPS) hospitals.

However, even though swing beds can be a game changer, building a swing bed program or strengthening an existing one takes time and strategic planning, oGen requiring overcoming internal and external hurdles. Many rural hospitals simply do not have the resources to take this on by themselves.

A Swing Bed Census That Plateaued

Monroe County Hospital is a 25-bed CAH located in Forsyth, Ga. Like many rural hospitals, it faced challenges. Some were large, others smaller. Some they could tackle. But others weren’t getting better, and they knew they needed help.

In the fall of 2023, Monroe’s leadership partnered with Aletheia Health Partners, a strategic advisory firm specializing in rural hospital transforma%on, to help address their challenges and find the best ways to move the hospital forward.

Aletheia’s data analysis team got to work studying the numbers to gain clarity on what had been happening in many areas of the hospital, including the swing bed program. Data showed that over the three most recent years, Monroe’s swing bed census had plateaued, hovering between 8.8 and 12.3 average daily patients. Yet the analysis revealed that instead of requiring a major overhaul to turn things around, an increase of just a couple of patients a day could bring in enough additional revenue to help make a significant difference in Monroe’s financial health.

Laying Groundwork to Obtain More Referrals

Data also showed that most of Monroe’s swing bed census came from referrals from other hospitals, so laying the groundwork to aRract more of them was key. Marketing resources were developed and a campaign began, promoting the availability of Monroe’s swing beds and the quality of the program.

Kerry Trapnell of Aletheia, who serves as Monroe’s Interim Chief Executive Officer, explains why, in addition to marketing, improving the referral intake processes was critical in shoring up the swing bed program, too.

“Referrals are usually sent out to multiple swing bed providers,” he says. “Ultimately, those who are able to respond the fastest and in the most professional manner—and have the right quality services that are needed—are chosen.”

Creating a High-Touch Culture

On face value, it could appear the work needed to strengthen the program was mostly done: marketing was raising visibility of Monroe’s swing beds to referring hospitals, and effective intake processes had been put in place to help ensure more patients came to Monroe.

Marketing had also been developed to promote services to Forsyth and the surrounding area. But the program still needed more—something less tangible, but arguably even important than the work that had been done.

"In swing bed care, where patients may stay for weeks, every interaction—from the nurse to the aide who delivers the meal to the physical therapist—is an opportunity and a powerful touchpoint. Our focus, therefore, was on empowering not just clinical staff, but everyone at the hospital to deliver compassion and support, transforming each encounter into a positive reflection of the hospital. It’s all about the Culture,” says Trapnell.

Expanding Clinical Capabilities and Services

A final component in creating not just a sustainable, but thriving, swing bed program was to address the growing need for skilled care for more complex pa%ents, so a wider group of pa%ents could be accepted into Monroe’s swing bed program.

Monroe now offers a full range of services and capabilities for swing bed pa%ents, from complex wound care to respiratory therapy for pa%ents with lung or breathing issues to physical, occupa%onal and speech therapy and more.

View Monroe County Hospital’s Swing Bed Program web page.

Impact Worth the Effort

The partnership between Monroe and Aletheia and implementa%on of these strategies yielded  worthwhile results:

• Pre-Intervention (3-year average): 11.0 daily pa%ents

• Post-Intervention (12 months): 14.2 daily patients (29% increase)

• Post-Intervention (18 months): 15.5 daily patients (40% increase)

Aletheia’s Recommendations for Rural Hospitals

For hospitals examining their own swing bed programs, Trapnell recommends the following:

1. Assess Your Swing Bed Potential: Conduct a thorough internal assessment to identify opportunities for growth and optimization.

2. Invest in Your Culture: Cul%vate a culture where every staff-patient interaction will reinforce quality and compassion.

3. Communicate Your Value: Market to and ac%vely engage with your community and poten%al referral sources to highlight your capabili%es and quality.

4. Develop Your Intake Processes: Implement efficient systems for referral management and pa%ent admissions to ensure timely and seamless transitions.

5. Assess Your Capabilities: Evaluate your capacity to care for swing bed patients with complex needs, addressing a growing need and potentially increasing length of stay and revenue.

6. Assess Your Bandwidth: Evaluate how much %me, effort and exper%se will be needed for strategic planning and implementation. If your resources are thin but you want to achieve more with your swing bed program, contact Aletheia at [email protected] to learn more about how we can help.