Skilled nursing homes around the country are still reeling from the aftermath of COVID-19 in a number of ways. Staffing, which was already a major issue, continues to plague the industry as does census. One of the main reasons for both, may involve the dramatic growth in home health care as most older adults wish to remain in their homes as long as possible and working for home health care agencies may be a more attractive choice for direct care staff. One way to increase census and hire experienced clinical staff may be to work directly with hospitals to gain more medically complex residents.
Home Health vs. Skilled Nursing
The trend involving older adults staying home longer isn’t new, but the boom in home health care companies around the nation is a newer phenomenon and it does negatively affect census in skilled nursing homes. Those older adults with low-acuity health issues, like knee replacements, will receive a short-term stay for rehab and then go home as soon as possible. On the other hand, those with high acuity or medically complicated conditions will most likely stay in long-term care. Such conditions include dementia, cancer, cardiovascular diseases, diabetes, and respiratory illnesses.
The Good
In the past, low acuity residents were desirable admission due to payment rates for physical, occupational and speech therapy. That isn’t the case anymore due to changes in reimbursement. Today, it’s the high acuity resident that generates the highest rates of payment under the Patient-Driven Payment Model (PDPM). Medicare pays lower rates for lower acuity, more independent residents and higher rates for those requiring complex nursing care. That’s the good part – higher payment.
The Not So Good
While admitting residents from hospitals and other clinical settings generates more revenue, it presents a few challenges. Census may be higher, but the building will be filled with older and sicker residents, which requires well-trained, consistent and highly skilled nursing staff. Another challenge is keeping residents from being hospitalized or re-hospitalized which may create financial penalties for the nursing home. It becomes imperative for nursing to follow nursing care plans and clinical pathways to prevent numerous hospitalizations. Still another challenge is maintaining sufficient staffing to avoid burnout.
Final Thoughts on Improving Census with Higher Acuity Residents
Among various factors causing a decline in nursing homes admissions, the two greatest influences are the pandemic and dramatic growth in home health care. To counter this, skilled nursing homes around the country are partnering with hospitals to secure high acuity admissions. While this does increase revenue, it also creates residual problems such as recruiting the best nurses, avoiding re-hospitalizations, maintaining adequate staffing and avoiding burnout. The key is finding a balance between the two.