This policy brief addresses the factors related to closure of skilled nursing units by some Critical Access Hospitals (CAHs) and the continued provision of these services by others.

Key Findings 

• Critical Access Hospitals(CAHs) that closed Skilled Nursing Facility (SNF) units cited a range of financial challenges related to payer mix, operating costs, cost allocation methods, and service utilization patterns. 
• The availability of alternative local long term care services, including swing beds, often contributed to hospitals’ decisions to close their SNF units. 
• CAHs that continued to operate SNF units were driven primarily by community need, despite the financial disincentive for doing so. Hospitals reported substantial variation in their strategies for using swing beds for SNF, rehabilitation, and post-acute services. 
• Given ongoing concerns about financial viability and low census rates among some CAHs, further research on the ability of CAHs to expand patient services and revenues through swing bed use is warranted.
• Additional research on the quality and outcomes of skilled care delivered by CAHs in SNF and swing beds is also recommended.