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April 17, 2020

The missing piece of your Covid-19 capacity strategy: Post-acute care

Daily Briefing

    By Carolyn Buys, Consultant, and Monica Westhead, Practice Manager

    As Covid-19 continues to bring more patients into hospitals across the country, a safe, efficient discharge strategy is more important than ever before. Historically, hospitals have relied on partnerships with post-acute providers to facilitate quick transitions out of the hospital and into the next level of care. Last year, approximately 45% of hospital discharges were sent to a post-acute setting, the majority of which went to a skilled nursing facility (SNF).

    Your Covid-19 checklist to expand capacity

    But amidst the Covid-19 pandemic, post-acute providers—and SNFs in particular—are plagued with challenges of their own. The large number of outbreaks in nursing facilities across the country has led several leading industry associations, including American Health Care Association, to recommend providers delay new admissions until patients have received two negative Covid-19 tests. Given limited testing availability nationwide, this policy can delay hospital discharges for weeks, clogging up critical inpatient capacity.

    It's a difficult balance to strike. Hospitals need to rely on post-acute providers as throughput partners so they can manage the most critical patients coming into the system. But at the same time, post-acute providers need to be incredibly careful about taking in new patients who may have been exposed, given the highly vulnerable patient population that they serve—and the potential risks associated with an outbreak.

    How nursing home outbreaks impact hospital capacity

    As of Wednesday evening, NBC News reported a total of 3,466 long-term care facilities with reported cases of Covid-19. Because CDC does not currently require nursing homes and other long-term care facilities to report Covid-19 cases, it's likely that this number is actually much higher.

    The more alarming statistic is the number of Covid-19 deaths associated with long-term care facilities. According to NBC News, the number of deaths associated with long-term care facilities is 5,670, or 21% of the 26,930 CDC-confirmed deaths in the United States.  

    In past weeks, we've written about the unique challenges that have led to this crisis in the long-term care industry. Most notably, these facilities—which typically house both short-term rehab and long-term care patients and residents—manage a complex, frail elderly population that is particularly vulnerable to the disease. In addition, long-term care facilities are chronically under-staffed and don't have the expertise or supplies in-house to cope with a pandemic like this one. They're doing everything they can to prevent these numbers from going up, and for many, this means significantly restricting or slowly down their admissions process.

    This slowdown in SNF admissions has all but eliminated a critical discharge option for hospitals in some markets. Although some SNFs are beginning to accept patients who have been in the hospital for reasons other than Covid-19, most are unable to accept patients who either have Covid-19 or have not received two negative tests. Fewer still are beginning to open their doors to patients with Covid-19, by creating units dedicated to Covid-19 or designating Covid-19 facilities.

    The goals of these policies are, of course, to prevent an outbreak in the SNF. If an outbreak occurs, it virtually guarantees an influx of readmissions to the hospital, far exceeding the average SNF readmission rate of 20%.

    What hospitals can do to overcome barriers to discharge

    It's clear that hospitals need to collaborate with post-acute providers to both reduce the spread of infection in their communities and to promote efficient discharges from the inpatient setting. Early analyses of Covid-19 patient needs suggest that many patients require intensive therapy post-hospitalization—often at a post-acute facility. As a result, hospitals need to double-down on their support for their post-acute partners now. 

    Across the next few weeks, we'll be releasing a series of research detailing exactly how hospitals can work with their post-acute partners throughout the pandemic, focusing on three key questions:

    1. How can hospitals collaborate with SNFs to make them a safer place for discharge?
    2. How can hospitals utilize owned post-acute assets as a space for Covid-19 positive patients or suspected cases?
    3. How can hospitals discharge more patients directly home with support, bypassing the need for additional facility-based care?

    We will also be providing resources to SNFs to help prepare, including offering guidance for setting up and maintaining isolation units in the skilled nursing setting.

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