Many people think of nursing homes as places to go to die. But here in Maryland, skilled nursing and rehabilitation centers are in fact places people go to live. They are a big part of the solution to the state's health care challenges, providing quality and cost-effective transitional, rehab, long-term and high-acuity care to those in need.

With the impending implementation of the Affordable Care Act in Maryland, we have an opportunity to identify and pilot ways in which Maryland's skilled nursing and rehabilitation centers can be essential to providing expanded care to people and families in need and deploying center‐based resources into the community for public health challenges.


Nursing centers in Maryland have valuable roles to play in effectively integrating care across all settings, connecting the dots among family caregivers, primary care doctors and nurses and hospital-related care to provide better focus and integrated care to address such things as chronic heart disease, diabetes and obesity. Centers also can help seniors to build strength before needed procedures and with rehabilitation services after a hospital stay and before heading home.

As baby boomers age, delay entry into nursing centers, and age in place at home or in other settings, now is the time for us to think big, executing policies to keep people well and engaged while controlling costs. Nursing centers can deliver help not just to people in need but also to their family caregivers.

Additionally, a strong business case can be made for the value of skilled nursing and rehabilitation centers in Maryland. In terms of efficiency and cost in Maryland, Medicaid payments for long‐term and rehabilitative care over the last eight years grew at a slower pace than Medicaid overall, 6.6 percent vs. 8.1 percent, and 6 percent lower than Medicaid payments for outpatient hospital services (12.5 percent).

Maryland's medical centers and hospitals are among the best in the nation: The R Adams Cowley Shock Trauma Center and the entire University of Maryland system; the research, training and care of the Johns Hopkins Medical System; and the Sinai Center for Geriatric Surgery, to name just a few. Maryland's nursing and rehabilitation centers are essentially hospitals without emergency departments and surgery suites, treating people who need broad and complex care.

Maryland remains a great place to be if you are ill and in need of a hospital or a skilled nursing and rehabilitation center. But unfortunately, on several key public health and chronic care measures, Maryland lags. According to various national measures often cited by Department of Health and Mental Hygiene Secretary Dr. Joshua Sharfstein, Maryland ranks 21st for overall health, 41st for infant mortality, and 27th in the nation in terms of preventable hospitalizations.

Therefore, we in Maryland have work to do in terms of keeping Marylanders healthy, well and engaged; and the care teams in Maryland's skilled nursing and rehabilitation centers have tremendous potential to help those in need become, and stay, healthy and well.

Maryland offers broad and important strengths: effective and visionary leadership from Gov. Martin O'Malley and Dr. Sharfstein; state-of-the-art, center-based care in our medical centers, hospitals and skilled nursing and rehabilitation centers; and the increasing development of community-based and integrated care.

As we plan for our best future in health care, Maryland will be well served by focusing not on the volume of care but instead on the value of such care — for instance, not emphasizing the availability and amount of procedures and tests a patient can receive, but identifying and applying the most effective and efficient care to help the patient to be well. In doing this, Maryland will develop broader care capacity in the community, caring for aging boomers while also creating career path jobs for younger Millennials.

In all these areas, Maryland can lead the nation, with skilled nursing and rehabilitation centers playing a key role.

Joe DeMattos is president of the Health Facilities Association of Maryland, which represents most of the state's 233 skilled nursing and rehabilitation centers. His email is jdemattos@hfam.org.