Because the Covid-19 pandemic tears by way of nursing properties, many sufferers and their households, who had been on the fence, are selecting to obtain care at residence as an alternative.
Even earlier than the beginning of the pandemic, insurers and a few hospitals had begun to enterprise into in-home care. The novel coronavirus, and regulatory modifications that enable Medicare to pay for hospital-level care at residence, have accelerated that development.
Put up-acute referrals to expert nursing amenities are down considerably from final 12 months, in keeping with knowledge from CarePort Well being, which offers care coordination software program for hospitals and post-acute suppliers. All referrals hit their lowest level in April, when hospital volumes additionally fell.
However within the fall months, when volumes recovered, referrals to expert nursing amenities had been nonetheless down by double-digits. As of October, they had been down 17%, whereas referrals to home-health suppliers had been 9% above baseline.
“It’s important not solely as a result of it’s down 20%, but it surely’s additionally important as a result of these are usually your high-margin Medicare sufferers which are actually vital to the affected person combine at a nursing residence,” mentioned Dr. Lissy Hu, CEO of CarePort Well being. “The extra wants that these sufferers have, the extra the lean is towards expert nursing amenities. However there have all the time been sufferers who may go both approach. There’s the place a number of this shift has occurred.”
Sufferers recovering from a surgical procedure, pneumonia, or different hospitalization, may must be discharged to a talented nursing facility. As they get better, sufferers have entry to a workforce of docs, nurses and bodily therapists.
Sufferers who had been hospitalized for Covid-19 “disproportionately” want facility-based care, Hu mentioned. However transferring these sufferers out of the hospital is difficult.
Expert nursing amenities, rightfully nervous about bringing in Covid-19 sufferers, confronted wide-ranging necessities from states. Some had been stringent, requiring two unfavorable exams for a affected person to be admitted. In different states, they had been required to accepts sufferers in the event that they had been deemed medically steady.
On the similar time, many expert nursing amenities struggled to amass sufficient masks, hand sanitizer and different protecting gear for his or her employees. Whereas the PPE state of affairs has improved in current months, staffing remains to be very a lot a problem, Hu mentioned.
Restrictions on guests, carried out to stop the unfold of the coronavirus, have additionally resulted in additional sufferers looking for in-home care. However that comes with its personal challenges. Whereas expert nursing amenities have all the things in as soon as place — from pharmacy companies to bodily remedy — extra coordination is required to deliver all these companies into the house.
“In some ways, the discharge to house is extra complicated than the discharge to a facility,” Hu mentioned. “How am I going to get a affected person to dialysis? Or get meals cooked at residence? There must be much more care coordination to have the ability to get all of these companies in place and guarantee while you refer affected person to a home-health company that nurse comes into the house inside 48 hours of discharge.”
As for whose job it’s to coordinate all of that — it relies upon. Generally, it is likely to be the affected person’s major care doctor, or a care coordinator affiliated with the hospital or their insurance coverage firm. Generally, there may be confusion over who’s coordinating what companies. However as extra sufferers go for in-home care, hospitals and post-acute care suppliers are working collectively extra carefully.
“There’s been much more back-and-forth sharing of information, working collectively to coordinate the care of sufferers. That’s one factor that can most likely proceed to occur,” Hu mentioned. “This divide between acute and post-acute, as they turn into extra depending on one another, what we’re going to proceed to see is that distinction persevering with to blur when it comes to the divide between acute and post-acute.”
Even with the broader shift to in-home care, nursing properties will proceed to have a major position because the U.S. inhabitants ages, and extra individuals have power circumstances.
“Expert nursing amenities are all the time going to be an vital a part of the care continuum,” Hu mentioned.
Photograph credit score: Drazen Zigic, Getty Pictures