Better. Faster. Stronger. That’s what the senior living industry’s evolving partnership with health care providers demands of post-acute resident care. But some in the post-acute space are going a step further and establishing relationships with patients before they ever head to the operating room.

And it’s working to bring new prospective residents in the door well before they plan to move in.

Prehabilitation, or rehabilitation prior to surgery, not only helps patients to better heal post surgery, but it also increases the likelihood that a patient will use the same provider for post-surgery rehabilitation services, say senior living providers who have begun offering prehabilitation.

The Oaks, a faith-based nonprofit CCRC in Orangeburg, S.C., began offering prehabilitation, or “prehab,” services about three years ago. The program is offered to those 55 and older.

The prehab program at The Oaks usually begins eight weeks prior to surgery, and is used by those who might need to lose weight, or just want to be in better shape prior to surgery, says Scott Ewing, president and COO of continuing care retirement community The Oaks.

Typically, prehab takes place four to eight weeks before surgery, according to the John Hopkins Health Information Network. Workout routines vary depending on the type of surgery and current health of the client.

Expanding the continuum of care

A prehabilitation program was a natural fit for The Oaks, Ewing says, noting that the personnel and equipment already in place in the CCRC’s wellness center are used in prehab programming. The wellness center, which oversees the prehab program, is located on the CCRC’s independent living campus and acts as a fitness center for residents.

“We have a weight room with all kind of fitness machines, and a pool that is wheelchair accessible,” he says. “Our staff is already at the wellness center. It doesn’t cost us that much extra, and it’s a benefit of the the continuum of services we offer.”

Westminster-Canterbury on Chesapeake Bay began implementing prehab in July of this year after identifying a need through its home health and rehabilitation services, says Sheila deGuzman, home health outreach coordinator for Westminster-Canterbury.

The Virginia-based nonprofit CCRC has served about seven to eight participants through its prehab program to date, and those clients have come mostly through referrals from local orthopedic surgeons, deGuzman says, noting that the CCRC has been actively marketing its prehab services to nearby health professionals.

Westminster-Canterbury’s prehab program is open to adults of all ages six weeks prior to their orthopedic surgery date.

“Since we began offering home health [in 2012] we’ve offered a lot of orthopedic post-surgical care, and that opened our eyes,” deGuzman says. “We thought, ‘Maybe we can provide some kind of fitness program so they can have a quicker recovery.’”

While the prehab program at The Oaks typically has one to two participants at a given time, Ewing says there is potential for growth. The CCRC, spread across 700 acres, is one of the few areas in rural South Carolina where residents can access wellness programming and trained specialists, he says.

Prehab programs are often unique in their markets, says Perry Aycock, president of senior living services firm Retirement Dynamics, noting such services give providers a competitive edge.

“It diminishes, if not removes, the post-op influence of discharge planners and others,” Aycock says. “If the customer needs any services post operation, they usually return to the prehab provider.”

Prehab also gives those who might not otherwise know about a senior housing community a window into its programs and amenities, Ewing says.

“We have some people who will return to us [after surgery] for our rehabilitation program,” Ewing says, noting that some prehab participants have also taken an interest in the CCRC’s home care program. “They’ve gotten to know our staff and feel comfortable with us.”

Westminster-Canterbury has also seen success with its prehab program attracting clients to additional areas of its programming, deGuzman says, noting that all of its prehab participants have returned for rehabilitation services post surgery.

‘Better outcomes, better lives, better economics’

While prehab services might be one way a provider attracts an otherwise untapped demographic, its benefits span far beyond good marketing: it often plays a key role in patient outcomes, research shows.

A study at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School, all in Boston, found that knee- and hip-replacement surgery patients who had participated in water- and land-based strength training, and aerobic and flexibility exercises for just six weeks prior to their surgeries reduced their odds of needing inpatient rehabilitation by 73%. The study is published in Arthritis Care & Research.

“Their level of function and pain stabilized prior to surgery, whereas those who did not exercise got worse,” says lead study author Daniel Rooks, PHD, assistant professor of medicine at Harvard Medical School, in a statement. “The benefits of exercise before surgery are very clear: the more you can do for yourself physically before surgery, the better off you will be.”

And patients that see the positive results of prehab, such as a faster return to healthier lives, play an important role in a provider’s ability to create partnerships with local health care systems, Aycock says.

“Data drives the ACO [accountable care organization] world, and partners who are efficient and effective in lowering days of care and recidivism will earn more referrals, deeper relationships and improve all constituents’ economics,” he says. “Better outcomes, better lives and better economics.”

Written by Cassandra Dowell