The Swing-Bed Program

Formally called the Rural Hospital Program of Extended-Care Services, the goal of this program was to use excess hospital beds in rural areas to deliver long-term care for the frail and disabled. Informally, it was known as “the swing-bed program.”

The swing-bed idea arose from a twin set of problems facing rural health care systems: (1) hospitals were built on a scale that often resulted in their having more beds than patients to fill them, and (2) frail elderly people who were disabled often needed to go to nursing homes far from where they lived. In this chapter, Sharon Begley, science columnist with the Wall Street Journal, who has contributed previously to the Robert Wood Johnson Foundation Anthology, tells the story of how some thoughtful leaders devised a seemingly simple solution to these two problems: use empty hospital beds for patients needing long-term skilled nursing care. Begley goes on to describe how the swing-bed idea developed, even over the initial reluctance of federal regulators to make an exception to Medicare regulations, the suspicion with which nursing homes received the idea, and the uncertainty about the level of care a practitioner could offer the occupant of a swing bed. The idea took hold, however; today, more than 60 percent of rural hospitals have swing-bed arrangements.

In retrospect, the swing-bed concept proceeded in an unusually ideal manner: it was tested on a small scale, outcomes were measured, and then the model was slowly expanded to other rural areas. The federal government was involved from the beginning; the Foundation entered as the idea was gathering steam and was able to influence development and help guide the direction it took. As with many service innovations, the Foundation's role was strategic and supportive, representing just one force in a larger national effort.