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Nursing home operators are expanding services such as ventilator care and in-house dialysis as they receive more residents with complex medical needs. ALIYA Healthcare reported a 14% rehospitalization rate at one high-acuity facility in a recent month; the national average cited by the report was 23.9%. Operators say staffing, hospital partnerships and selective investment are central to providing this care.
Several nursing home operators are expanding ventilator care, on-site dialysis and other complex services as facilities take in residents with higher medical needs, according to an October report by Skilled Nursing News. The shift moves some care traditionally delivered in hospitals or long-term acute care hospitals into skilled nursing facilities, which providers say can support recovery and reduce hospital trips.
ALIYA Healthcare has added ventilator units through its Thrive subsidiary, though the units are not being introduced across its entire portfolio. CEO Efriam Weinfeld told Skilled Nursing News that the company began with one of three facilities required to have the units, with plans to add them at the other two. He said the service requires a facility team capable of managing the full operation and is intended to improve care and the experience of residents and families.
Weinfeld said one ALIYA building with more than 18 ventilator units had a rehospitalization rate of about 14% in a recent month. The report compared that figure with a national rate of 23.9% from Medicare.gov. The figures refer to different scopes, and the report does not provide a longer time series or further details about the building’s patient mix, so they do not establish that the program caused the difference.
ALIYA has also expanded in-house dialysis to 12 of its 18 facilities, building dedicated areas for treatment. Cascadia Healthcare operates subacute ventilator units at a new building in Boise, Idaho, and is considering broader dialysis services. Oakdale Seniors Alliance is evaluating partnerships to offer hemodialysis in its communities. The report also names Venza Care as a provider of higher-acuity services, including cardiac care, dialysis and dual-diagnosis support, but gives limited detail on those programs.
More Complex Care After Discharge
The expansion reflects a change in the work expected of skilled nursing facilities: some now receive residents who need care once concentrated in hospitals or long-term acute care hospitals. For residents, treatment on site could reduce trips to outside clinics or hospitals. Oakdale’s vice president of quality, Heather Haberhern, said some hospital partners are referring residents with more complex conditions after expedited discharges and view nursing homes as a lower-cost setting that can still provide high-quality care.
For operators and payers, the model may affect transportation, hospital readmissions and how care is coordinated across settings. Weinfeld said keeping services in-house can reduce competing incentives among outside providers and focus the company on outcomes. Those are the operator’s stated reasons; the report does not present a controlled comparison showing that in-house services improve outcomes or lower total costs across facilities.
The services also demand more from nursing staff, facility design and clinical oversight. Ventilator care is higher risk and more clinically demanding, Weinfeld said. Haberhern stressed staff education and close ties with referring hospitals and medical directors. Those requirements make the expansion a question of capacity and coordination as well as equipment.
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How Operators Are Building Capacity
The move toward higher-acuity care has developed over time, according to Skilled Nursing News. Providers cited in the report are pursuing different services rather than adopting a single model. ALIYA has developed dedicated ventilator units and dialysis areas. Cascadia, which operates more than 61 long-term care facilities across Washington, Oregon, Montana, Idaho and Arizona, has subacute ventilator care at a new Boise building and is looking to expand dialysis.
Operators described the work as a response to rising resident needs and hospital discharge patterns, as well as a potential fit with value-based care. Weinfeld said ALIYA is not trying to offer every complex service in every building: “I’d rather be good at one or two things and not try to be one all be all.” The approach suggests providers may concentrate advanced services in selected facilities where teams and infrastructure can support them.
Hospital relationships remain part of that plan. Haberhern said partnerships with referring hospitals and medical directors support care for residents with more complex conditions. Cascadia CFO and principal Steve LaForte said the goal is to work with hospitals to ease bottlenecks by providing care further along the care chain, rather than compete for patients.
““Making a Taj Mahal of vent units was something that we’re now moving towards with our Thrive line.””
— Efriam Weinfeld, CEO of ALIYA Healthcare, to Skilled Nursing News
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Outcomes and Capacity Still Unclear
The report does not establish whether these programs consistently reduce readmissions, improve recovery or lower total costs. ALIYA’s cited 14% rate is for one facility in a recent month; the account does not specify the month, provide a longer trend or explain how the rate was calculated. The national 23.9% figure is a broader comparison, not a matched comparison between similar facilities.
It is also unclear how quickly providers will expand these services, how many residents will be served, and what staffing and facility costs are involved. Cascadia’s plans for broader dialysis and possible bronchoscopies are under consideration, while Oakdale is evaluating dialysis partnerships. The report does not specify timelines or final decisions. Skilled Nursing News’ account ends while discussing Venza Care, leaving that provider’s approach to some complex services incomplete.
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Expansion Depends on Local Readiness
ALIYA plans to add ventilator units at two more facilities identified by Weinfeld, and Cascadia is considering a broader rollout of in-house dialysis. Oakdale is assessing partnerships for hemodialysis. The next steps described by providers depend on staffing, clinical readiness, facility modifications and coordination with hospitals; the report gives no firm completion dates.
Further reporting or data will be needed to assess how these services affect residents over time. Relevant indicators include rehospitalizations across comparable facilities, resident outcomes, staffing levels and the costs of delivering treatment on site. Hospital partnerships and operator decisions will shape whether the services expand beyond the locations described.
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Key Questions
What kinds of complex services are nursing homes adding?
Providers cited in the report are adding or considering ventilator care, in-house dialysis and bronchoscopies. The specific services vary by operator and facility.
What rehospitalization rate did ALIYA report?
ALIYA CEO Efriam Weinfeld said one facility with more than 18 ventilator units had a rate of about 14% in a recent month. The report cited a national rate of 23.9% from Medicare.gov, but the figures are not a matched comparison and do not show that ventilator care caused the difference.
Why are providers moving treatment into nursing homes?
Operators say on-site services may reduce trips to hospitals or clinics and help care for residents discharged with more complex conditions. Providers also cited value-based care incentives. The report does not establish the financial or clinical results across the industry.
What remains uncertain about the expansion?
The scale, timing, costs and staffing needs are not fully described. More outcome data would be needed to determine whether the services consistently affect readmissions, recovery or total care costs.
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