While building back hospital referrals is one way skilled nursing facilities (SNFs) have looked to recover census loss over the course of COVID-19, new data shows that referral rejection rates are at an all-time high as staffing shortages continue to cripple the sector.
That’s according to an analysis by Careport, a WellSky company, which shows that while there’s a high demand for post-acute services – finding the staff to supply it has become the bigger challenge.
In January of this year referral rejections reached 65% in skilled nursing and 58% in home health, the highest levels since early in the pandemic.
“When Covid hit, we saw there was a drop in patients being referred to skilled nursing and I think for a long time we were wondering when that volume was going to recover and if it was ever going to recover fully because what we’ve seen with patients now being referred home,” Tom Martin, director of post-acute analytics at CarePort, told Skilled Nursing News.
The data looked at more than 3,000 skilled nursing facilities (SNFs) and almost 700 home health agencies throughout post-acute care.
Staffing struggles hurting occupancy gains
Westmont, Ill.-based Burgess Square Healthcare and Rehabilitation Centre CEO John Vrba thinks there’s one reason why rejection rates are so high right now for SNFs: staffing.
“This sector is under siege right now and we’re getting hit from all areas,” he told Skilled Nursing News. “Our census is still down 25 to 30% simply because, like Washington wants, we put quality first before revenue and we have two wings shut down now simply because we’re unable to staff them.”
Long-term care facilities have lost roughly 400,000 caregivers since the beginning of the pandemic as workforce levels have hit a 15-year low for the sector.
More than half of nursing homes have limited new admissions to start the year, at a time when hospitals were overwhelmed with omicron surges.
“It got so bad the other day, it was like seven o’clock at night, and I got a call from an administrator and he almost didn’t have a nurse for his night shift,” Vrba said. “He was able to find an agency nurse, but I think it was like $110 an hour and we can’t afford that.”
Ricard Mollot, executive director at the Long-Term Care Community Coalition (LTCCC), recently told Skilled Nursing News that staffing hasn’t kept pace with resident census rebounds, creating “a really problematic” situation from a safety perspective.
Average total resident census rebounded to 1.13 million in Q3 2021, up 2.5% from the previous quarter and 5.5% since Q1 2021 while staffing levels dropped nearly 8%.
“We’re trying to help out hospitals as much as we can but we can only accept the patients that we can care for and we just cannot find the staff,” Vrba added.
While labor shortages exist across other health care settings, including hospitals, Bureau of Labor Statistics data shows that the challenge is most pronounced for the long-term care industry.
Hospitals have lost 2% of their workforce, according to the American Health Care Association’s analysis of the data, compared to a 15% workforce decline among nursing homes and 7% decline among assisted living communities.
Demand for post-acute care soars
Some states have even looked to set up regional support sites to help decompress the health care system while others have brought in the National Guard to help free up beds in nursing homes. Those provisions were in part enacted due to COVID-19 surges, and demand for post-acute care appears to only be growing.
Pennsylvania, for example, faced a difficult start to the year with hospitals overwhelmed with COVID-19 patients as some, like Geisinger, had as many as 120 nursing home patients ready and stable for discharge. Those problems seem to have subsided as the state was down to 3,167 COVID patients admitted to state hospitals last week, a far cry from the 4,869 patients reported four weeks ago.
Still, according to CarePort data, finding nursing home beds to send patients to continues to hold up the care continuum.
By January, patient referral volume to SNFs reached within 3% of pre-COVID numbers, while home health agency referrals are up 9% higher than pre-COVID numbers, CarePort data shows.
“This tells us that overall demand for post-acute care is really high right now,” Martin said.
Likewise hospital length of stay has increased to start 2022.
In Q1 2020 hospital length of stay prior to discharge to a SNF was 8.6 days, whereas in January 2022 that jumped to 9.7 days.
“Those whole days when you’re talking about thousands of patients is a really big deal,” Martin said.
Companies featured in this article:
Burgess Square Healthcare and Rehabilitation Centre, CarePort, Geisinger Health System, WellSky
