Finding Your Post-Acute Care Niche

As a nursing facility marketing professional for more than 20 years, I have consistently seen that those facilities that take the leap to find their niche are those that move forward with greater census and profitability. Whether it is short-term rehabilitation, subacute care, bariatric care, hospice, or wound care, nursing facilities are creating and packaging niche areas of expertise to enhance referral sources and case mix and increase census. All facilities, regardless of their present census, should consider specialty clinical programs to remain competitive.

Before embarking on a clinical specialty, however, a facility must examine its strengths, financial resources, physical plant, and staffing. Many facilities do not recognize their own potential in certain areas. I have observed that a professional consultant can often find strengths in a particular area of clinical service that has the potential to be packaged and marketed to a distinct audience. Begin by asking hospital case managers what diagnoses they have difficulty placing to identify services not offered in your area.

What follows are early progress reports from facilities that I have worked with along these lines.

Port Chester Nursing and Rehabilitation Centre, a 160-bed facility in Westchester County, New York (figure 1), had been offering quality nursing care and wanted to stay competitive by expanding its referral base to reach desirable Manhattan hospitals. In a brainstorming session with the owner, administrator, and director of nursing, we strove to identify the facility’s clinical strengths in order to build an effective, cohesive, and marketable niche.

Administrator Carol Spedaliere remembers, “We had always had great success with wound care. Our facility had a low incidence of residents developing wounds and had consistent success with incoming hospital wounds. After discussing our potential in this area, we felt we were ready to move to the next step.”

The facility began using “wound vac” equipment, trained its staff, and had the director of nursing become certified in wound care. Along with the interdisciplinary team and medical director, staff evaluated and adjusted protocol to accommodate patients with more difficult wounds, specifically by increasing flexibility in wound care product selection depending on individual resident needs. This program was named The Wound Healing Program; brochures were created in both English and Spanish and the marketing began.

The facility received an immediate response from local hospitals that didn’t know where to send difficult wounds-including, yes, the desired Manhattan hospitals, which now refer patients with a variety of diagnoses, not just difficult-to-treat wounds, on a regular basis. Spedaliere’s advice to others: “Before beginning a niche program, you must have a history of success and know that your staff is up to the challenge.”

Island Nursing and Rehab currently discharges approximately 30 to 40 patients a month, most going back to their homes, including several recently discharged patients over 100 years old.

When Daleview Care Center, Farmingdale, New York (figure 3), decided to offer short-term rehab in addition to traditional skilled nursing care, the owners built a large rehabilitation room, purchased state-of-the-art equipment, and renovated the area. Short-term patient satisfaction surveys had indicated that, while patients were extremely pleased with the care they received at Daleview, they would have liked rehab to be available on weekends to facilitate a quicker return home. Simultaneously, the facility was receiving and tracking numerous phone calls from the community asking if it provided rehab on weekends. With these two pieces coming together, along with increasing competition from rehab providers, Daleview Care Center decided to offer rehab seven days a week and hire additional staff for the weekend-one day for physical therapy and the other for occupational therapy, each provided by an individual therapist. Daleview’s rehab management vendor works with the facility to train staff for this role.

Daleview also went the extra step to add phone service and DIRECTV in each patient room, along with computer availability.

Ken Ruthinoski, administrator of Riverhead Care Center in Riverhead, New York (figure 4), says that attracting new post-acute patients requires a team effort. “The entire staff must be on board when adding specialty programs, particularly because you are often dealing with a younger population with different needs than the traditional geriatric patient.” Ruthinoski adds, “We have found that our staff has risen to the challenge and become more skilled and experienced in different clinical levels of care.” Specifically, by adding wound care, IV therapy, out-patient dialysis, and amputee rehabilitation, his facility has found its staff becoming more motivated and elevating their skill levels, with additional training provided by nursing administration, wound care product manufacturers, and other specialized resources, as they implement protocols that were previously only executed in the hospital setting.

This is no time for traditional facilities to be intimidated. There are affordable opportunities for every facility to provide niche services, as long as you have a strong staff, adequate clinical expertise, and a commitment to well-researched and -developed programs.