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Nursing home operators including ALIYA Healthcare and Cascadia Healthcare are expanding services such as ventilator care and on-site dialysis for residents with more complex needs. Operators say the approach can reduce transfers and support recovery, but it requires trained staff and close hospital partnerships; reported outcomes and plans vary by facility.
Several U.S. nursing home operators are expanding complex clinical services, including ventilator care, on-site dialysis and, in some cases, procedures usually delivered in hospitals or long-term acute care hospitals. The development, reported by Skilled Nursing News, reflects facilities adapting to residents with higher-acuity needs and hospitals seeking settings able to support some patients after discharge.
ALIYA Healthcare has expanded ventilator care through its Thrive subsidiary, though the program has not been rolled out across its entire portfolio. Chief Executive Efriam Weinfeld told Skilled Nursing News that the company began with one of three facilities that required such units, with plans to add them at the other two. He described the goal as improving care and the experience of residents and families, rather than simply increasing capacity. Ventilator services require facilities to modify their environments and have their own teams manage a demanding level of care.
Weinfeld said one ALIYA building with more than 18 ventilator units recorded a rehospitalization rate of about 14% in a recent month. He compared that with a national average of 23.9% cited from Medicare.gov. The figures describe different populations and settings; the report does not establish that the ventilator program caused the difference. ALIYA also provides in-house dialysis at 12 of its 18 facilities, including in dedicated areas the company calls “dialysis dens.”
Cascadia Healthcare operates more than 61 long-term care facilities across Washington, Oregon, Montana, Idaho and Arizona. Chief Financial Officer and Principal Steve LaForte said it has subacute ventilator units in a new Boise-area building, where care can resemble that provided by a long-term acute care hospital. The company is expanding in-house dialysis and considering bronchoscopies, a procedure the report describes as relatively new to skilled nursing facilities. Oakdale Seniors Alliance, meanwhile, is evaluating partnerships to provide hemodialysis in its communities. Venza Care offers higher-acuity services including cardiac care, dialysis and dual-diagnosis support.
More Complex Care Outside Hospitals
Moving some services into skilled nursing facilities could give residents access to care closer to where they live and reduce the need for transportation to outside clinics or hospital transfers. Operators interviewed by Skilled Nursing News also linked in-house services to value-based care, in which outcomes and avoidance of readmissions can affect financial incentives. Those potential benefits depend on facilities being able to deliver the care safely and consistently.
The shift also puts pressure on staffing, training, equipment and clinical oversight. Ventilator care and dialysis are not simple additions to a standard nursing home service menu: they require trained personnel and coordination with physicians and hospitals. Operators said they are selecting which services to develop rather than trying to offer every complex procedure in every building. This can affect where residents are referred and how hospitals plan discharges, but the report does not provide system-wide data on access, costs or patient outcomes.
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Operators Build Specialized Units
Skilled nursing facilities have increasingly received residents with more complex conditions, a trend that has encouraged some providers to take on work historically concentrated in hospitals and long-term acute care hospitals. The report identifies ventilator support and kidney dialysis as services already being offered in some nursing home settings, with bronchoscopies under consideration at Cascadia.
Operators described distinct approaches rather than a single industry-wide rollout. ALIYA is expanding selected ventilator units and has brought dialysis in-house at 12 facilities. Cascadia is developing subacute capabilities and considering a broader dialysis service. Oakdale is assessing potential hemodialysis partnerships. The source report also notes that some complex care involves close collaboration with outside providers, rather than being performed entirely by a facility’s own staff.
““Making a Taj Mahal of vent units was something that we’re now moving towards with our Thrive line.””
— Efriam Weinfeld, ALIYA Healthcare chief executive
Outcomes and Rollout Remain Uneven
The report does not establish how many nursing homes nationally provide ventilator care, dialysis or bronchoscopies, or how quickly these services are spreading. It also does not provide comparative data on costs, complications or resident outcomes across operators. ALIYA’s reported 14% rehospitalization rate applies to one building in a recent month; it is not evidence that the same result can be expected elsewhere or attributed to a particular service.
Several plans remain under evaluation or development. Oakdale is assessing hemodialysis partnerships, Cascadia is considering bronchoscopies and broader dialysis adoption, and ALIYA’s ventilator expansion is limited to selected facilities. The report does not detail staffing levels, training requirements, regulatory approvals or the safeguards used for each procedure. Those details will shape how widely the services can be adopted and which residents are appropriate for care in a nursing home.
Staffing and Partnerships Shape Expansion
Operators are expected to continue evaluating which services fit their facilities, workforce and resident populations. ALIYA said it plans ventilator units at two additional facilities in its initial group; Oakdale is considering partners for on-site hemodialysis; and Cascadia is looking at a wider dialysis offering and possible bronchoscopies. The report did not give completion dates for these plans.
Hospital relationships are likely to remain part of the model. Haberhern said Oakdale wants close partnerships with referring hospitals and medical directors, while LaForte said providers need to work together to ease hospital bottlenecks. Further reporting on adoption, staffing, safety and outcomes will be needed to show whether the expansions improve care and reduce transfers beyond individual facilities.
Key Questions
What complex services are nursing homes adding?
Operators cited ventilator care, in-house kidney dialysis and, in one company’s case, consideration of bronchoscopies. Other services mentioned include cardiac care and dual-diagnosis support.
Which operators are expanding these services?
The report discusses ALIYA Healthcare, Cascadia Healthcare, Oakdale Seniors Alliance and Venza Care. Their services and plans differ; not every operator is offering every procedure.
Did ALIYA report lower hospital readmissions?
ALIYA chief executive Efriam Weinfeld said one building with more than 18 ventilator units had a rehospitalization rate of about 14% in a recent month. The report does not show that the program caused the rate or that it applies to other facilities.
Why do facilities need hospital partnerships?
Operators say partnerships help with referrals, medical oversight and care for residents whose conditions are complex. The report presents collaboration as a way to support care across settings, not as a replacement for hospitals.
Are these services available at all nursing homes?
No. The report describes services at selected facilities and plans that are still being evaluated. It does not provide a national count of facilities offering these procedures.
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