The COVID-19 pandemic accelerated a monumental shift in care delivery across both the acute and post-acute settings. Though the U.S. has the largest number of nursing home residents in the world, many doctors, patients and families are increasingly opting for in-home care over institutional care settings such as nursing homes and skilled nursing facilities (SNFs). In what may be our new normal at the post-acute level, fear of infection and isolation in long-term care facilities continues to prevent doctors, patients and families from selecting such facilities.
The pandemic’s impact on SNFs and home health
During March and April 2020 – the onset of the COVID-19 pandemic in the U.S. – we saw referrals to both skilled nursing facilities and home health providers plummet. Patient referrals to home health dropped 32 percentage points, while patient referrals to skilled nursing facilities dropped 34 points. Despite this craterous dip for home health in April 2020, referral volumes restored to normal levels by July 2020. Home health agencies are now running above their previous capacity, with referrals to the setting reaching 109% of 2019 totals by October 2020.
However, data shows that there is not the same strength in recovery for SNF referrals. Contributing to the problem, some nursing homes had to stop admissions in the spring, said Susan Craft, vice president of population health at Henry Ford Health System in Detroit. “It was a forced period for us to work on home-care programs,” said Gloria Rey, the director of post-acute care at Henry Ford. “We’re continuing to work within our organization to make going home the priority.”
CarePort data highlights the struggle for SNFs
Within CarePort customer hospitals, the split in referrals to SNFs versus home health has historically been equal; the pandemic, however, has shifted these referral ratios, and home health now comprises 55% of referrals while SNF referrals lag at 45%. Despite SNFs having the resources and capabilities to take patients – data from the Centers for Disease Control (CDC) shows that, that as of January 2021, 73% of SNFs have taken COVID-19-positive patients, 99% report having the ability to test staff and residents, and 92% have all necessary personal protective equipment (PPE) required to maintain patient and staff safety – the industry remains disproportionately, and negatively, impacted by the COVID-19 pandemic.
CarePort data shows that occupancy rates in SNFs are also at an all-time low – 71% nationwide as of January 2021 – and demand remains negligible. In January 2020, 32% of the nation’s SNF providers reported having occupancy rates greater than 90% – whereas in January 2021, only 9% of providers have reached that level of occupancy. Several facilities – 114 in 2020 alone – have closed their doors, and we might expect additional closures as provider relief funds dry up.
How CarePort can help
It’s difficult to predict whether the pandemic’s impact on institutional settings of care is permanent, but we don’t anticipate SNF referral volumes to fully recover and reach 2019 levels anytime soon. Patients who typically would have gone to skilled nursing facilities will still go to home health for the foreseeable future, and even as we look post-COVID-19 pandemic, we expect to see more and more patients requiring these home-based services.
Because patients are increasingly being discharged from hospitals to home health rather than SNFs or nursing homes, care coordination tools like CarePort are critical to ensuring patients receive high-quality care post-discharge. A 2019 JAMA study showed that readmissions for patients discharged to home health care were 5.6 percentage points higher than for patients discharged to skilled nursing facilities. This may be caused by to the fact that patients discharged to SNFs are typically tracked more closely than those discharged to home health.
CarePort can help monitor a patient’s care in their own home – whether with follow-up touchpoints or a coordinated treatment plan. For example, a patient’s first home health visit should be tracked, and providers must also ensure that the patient follows his or her medication instructions while at home and schedules the necessary telehealth or in-person appointments. CarePort offers a robust home health agency analytics and reporting tool to help evaluate home health agency performance across key measures, including timeliness to start of care, admission rates and discharge rates. Our home health offering is a one-stop shop for patient intervention under the care of SNFs and home health, as well as a near real-time tool to monitor performance of home health agencies.
To learn more about CarePort’s home health offering, please contact us for more information.