In the 40+ years that Capitol Lakes Health Center has been a part of the downtown Madison community, we’ve aligned with and adapted to many healthcare changes. With the projection of the 65+ population doubling by 2050, according to the U.S. Bureau of Labor Statistics, patient-centered transitions and processes will continue to be a necessity, utilizing both innovative and creative ways to care for a growing senior population.
The healthcare industry has gone through many systemic changes in the past decade, and not just due to a global pandemic. Improvements to many robotic-assisted orthopedic procedures, such as total hip and total knee replacements, allow for more patients to go home after surgery rather than recuperate in a Skilled Nursing Facility (SNF). The increasing number of Medicare Advantage (Medicare Part C) plans has offered additional benefits for beneficiaries, and 51 percent of eligible seniors in the United States have enrolled in such a program.
Such developments have contributed toward a change in census and case mix for SNFs, like Capitol Lakes. Seniors still require similar levels of care, but the changes in insurance regulations, staffing models, and post-pandemic operations have prompted the need to rethink and reimagine healthcare for seniors moving forward.
With the increasing number of seniors enrolling in managed care insurance plans, Capitol Lakes and others have had to pivot to accommodate both the clinical and financial needs of in-house residents as well as new admissions from the community. Also known as Medicare Advantage or Medicare replacement plans, managed care insurances utilize clinical algorithms to drive SNF length of stay and dictate the timeframe in which a resident can graduate from receiving inpatient skilled nursing care to outpatient respite care. Some managed care insurances may not authorize inpatient skilled nursing following a hospital stay, so a direct admission to respite is an option. Currently, 37 percent of Dane County seniors are enrolled in such plans (as opposed to traditional Medicare), and the numbers are expected to continue to increase.
Respite programs offer an extended stay for residents who may be clinically designated as too high functioning for insurance to pay for an inpatient stay, but not quite ready to return home from a therapeutic standpoint. As an example, rather than staying at Capitol Lakes Health Center paying privately, a resident can transition to a respite stay at Capitol Lakes Terraces for a less-expensive alternative. Not only does the resident save money, but the transition frees up a bed at the skilled nursing facility for a future rehab candidate.

Respite services provide therapy on an outpatient basis and focus more on gaining strength, as when following a fracture; endurance building, as when following a stint with pneumonia; equipment teaching, as with a patient having a new ostomy; and participating in a trial period prior to returning home. The respite program is also an option for skilled nursing residents who may be clinically ready to go home but have new equipment needs (e.g. needing a ramp installed) or when a home health provider isn’t available immediately upon discharge. In other words, a respite stay involves additional oversight from caregivers and outpatient PT/OT staff but in a less clinically intensive environment as what the resident experienced at the skilled nursing level of care.
Since respite is considered outpatient, the resident will also pay privately for their medications. Any physical or occupational therapy will be billed under the resident’s Part B benefit, which may include an additional co-pay depending on the managed care plan. Therapy works with residents two to three times per week, as opposed to daily skilled nursing. A respite stay is a safe, therapeutic place for residents to be when they’re not safe to be at home by themselves just yet.
Kjersti Beth, CPHQ, is admissions assistant/QA liaison at Capitol Lakes Health Center, a preferred provider in Madison with a decades-long reputation of low hospital readmissions and good outcomes. We value our residents’ independence and strive to provide the highest quality of accommodations and services to enhance the retirement experience. With a continuity of care all under one roof, the age in place business model lessens the risk of errors when transferring residents from one level of care to another and provides familiar faces in a clinically supportive environment.
CAPITOL LAKES HEALTH CENTER
(608) 283-2000
capitollakes.org