An evaluation of swing-bed experiments to provide long-term care in rural hospitals. Volume I: Executive summary

The findings and implications of an evaluation of swing-bed experiments in Texas, Iowa, and South Dakota are summarized in this report. Under these experiments, 82 rural hospitals were permitted to provide long-term care in hospital beds normally restricted to acute care use. Two key features characterized the experiments: 1) a waiver of certain regulatory standards normally required of long-term care providers and 2) a reimbursement approach based on incremental cost. An overview of the swing-bed approach is provided in this report, along with a presentation of the major findings and policy implications of each component of the evaluation. Recommendations on the implementation of a nationwide swing-bed program are also included. The major conclusions of the evaluation were as follows: 1) it is appropriate to implement a national swing-bed program in rural areas; 2) such a program would be of benefit to rural communities in terms of meeting both long-term care and acute care needs; 3) assuming reimbursement is flexible and based upon the concept of incremental cost of care, the swing-bed approach is a cost-effective means of providing long-term care; and 4) a number of financing, quality assurance, and regulatory issues must be considered in structuring a national swing-bed program. Recommendations on these topics are provided in this report.