Survey says tech may help manage demand, staffing shortages in post-acute care settings
The COVID-19 pandemic accelerated many changes in healthcare resourcing, but other forces – including patient and family preferences – also are putting a strain on staffing and technologies, according to a recent care coordination survey.
Post-acute care cases are rising in acuity and numbers, with the healthcare industry struggling to meet the increasing need for staff to provide care in the home.
The COVID-19 pandemic accelerated these changes, but other forces – including patient and family preferences – also are putting a strain on staffing and technologies, according to a recent survey of care coordination leaders from hospitals, health systems and post-acute providers conducted by CarePort, a Boston-based care coordination network that specializes in discharge planning.
The survey results suggest that healthcare organizations will face increasing challenges in placing sicker patients in post-acute care settings and effectively meeting their care needs. Challenges in successfully transitioning patients out of acute care settings could increase the potential for patients to suffer relapses, which could add to the potential cost of care and raise the likelihood of penalties related to the Hospital Readmissions Reduction Program of the Centers for Medicare & Medicaid Services.
The pandemic has accelerated ongoing trends that affect the way care is delivered across the continuum, according to CarePort’s analysis of data from its care coordination platform, which it says is used by more than 1,000 hospitals and 130,000 post-acute care providers. Results of that analysis are contained in its Evolutions of Care report.
While inpatient volume has largely returned to pre-pandemic levels, capacity issues are resulting in higher acuity patients – needing more complex care – being discharged into post-acute care settings, the analysis shows. The average person discharged to skilled nursing facilities and transitioned to home care has more acute conditions than in 2019, as measured by co-morbidity scores, the analysis shows.
“Care coordination will play an important role by making providers aware of the availability and quality of services so patient needs can be met in a timely manner, without adding additional administrative burdens.”
Increasingly, discharged patients have comorbid conditions, such as congestive heart failure, chronic obstructive pulmonary disease, hypertension, neurological disorders, diabetes and obesity.
“On average, higher acuity patients have a greater need for services post-discharge, adding increased complexity to getting that patient the care they need,” said Lissy Hu, MD, CEO and founder of CarePort. “Giving providers the visibility and insight needed to provide the appropriate level of care post-discharge is critical to ensuring the best possible outcome.”
Staff shortages
Post-acute care facilities are facing mounting staff shortages that are affecting their ability to manage sicker and more complex patients, according to the analysis.
That’s particularly true for home care agencies, which have seen an increase in referral rates after the pandemic. CarePort’s data shows that skilled nursing facilities and home health agencies historically have received equal amounts of referrals, but by March 2021, home health referrals had reached 116 percent of 2019 totals and accounted for 60 percent of all referrals.
More patients prefer to recover from hospital care at home, and the COVID-19 pandemic has increased this preference, CarePort notes. However, the increase in demand for home care is putting those agencies under pressure – they’re caring for sicker patients, and because of staffing limitations, they are having to decline 15 percent of referrals, the company reports.
In addition, home care agencies are increasingly delaying the start of care for referred patients. That can increase the risk of readmission. CarePort estimates there’s 3 percent more risk for readmission for each day that a patient is not seen by a home health provider after discharge from an acute-care facility.
Skilled nursing facilities also are declining referrals about 10 percent more often than they did in 2019. These delays are generally prolonging patients’ stays in acute-care hospitals, CarePort reports. The average hospital length of stay for patients in the CarePort network being referred to SNFs has increased by 10 percent percent since 2019, with an 8% increase for home health referrals.
CarePort measures total nurse hours per resident per day, which is a component of its rating system, called the CarePort Quality Score, and the CMS Nursing Home Five-Star Quality Rating. As total staffing hours in SNFs are declining, the hours per day of staff – including registered nurses, licensed practical nurses and certified nursing assistants – is declining. CarePort says that these declines in staffing and hours of care per patient “don’t necessarily pose a danger to residents.”
Technology’s role
CarePort says its studies suggest “that as demand for post-acute and home-based care continues to increase, the path to success hinges on technology-enabled care coordination. We cannot meet the growing demand for care through staffing alone. Technology that powers enhanced efficiency and automated workflows is needed to ensure safe and high-quality transitions of care across the continuum at scale.”
Post-pandemic care has changed patient preferences and has accelerated the trends that are reducing staffing levels, the company concludes.
“Care coordination will play an important role by making providers aware of the availability and quality of services so patient needs can be met in a timely manner, without adding additional administrative burdens,” Hu says.