Across the country, staffing shortages and financial challenges are causing skilled nursing facilities (SNFs) to close their doors or reduce their bed count at alarming rates. As closures continue, acute care providers are seeing upstream impacts due to limited SNF capacity.

While SNF closures are occurring nationwide, rural patients and providers are disproportionately impacted. Our analysis showed that 7% of rural SNF facilities closed between 2016 and 2021, compared to 5% of urban SNF facilities.

These closures are a large problem for critical access hospitals, which are the main point of contact with the healthcare system for patients in rural areas. Our analysis found that SNFs that closed had higher rates of patients being discharged from critical access hospitals than those that remained open. This means that rural patients, specifically those coming through a critical access hospital do not have access to the care they need.

To ensure that patients get the best care and continue to flow through the healthcare system, rural hospitals are left scrambling for other post-acute placement options. The biggest challenge is lack of access. As with most healthcare resources, rural communities have less access to home health than their urban counterparts.

Patients that need assistance with daily living activities would require an aide to help them. Aides are typically paid out of pocket, creating more boundaries for patients in rural communities that have high levels of poverty. These challenges limit the opportunity for home health to be a viable post-acute care alternative for many patients in rural areas.

SNFs and their referring hospitals will need to work together to address the two factors contributing most to SNF closures: staffing shortages and financial challenges.

To address staffing shortages, hospitals can partner with SNFs to participate in local hiring fairs together. Rural SNFs should continue to improve their employee value propositions. Attracting and retaining SNF staff will go a long way in keeping SNFs open.

To address financial challenges, hospitals should partner with SNFs to provide joint training for staff to help them feel more confident taking on high-acuity, complex patients, who have a higher rate of reimbursement and aren’t as suited for home-based care initiatives.

Hospitals should also invest in targeted, home-based care management initiatives for lower-acuity patients. This could include connections to community-based supports, or even the option for non-reimbursable care for select groups of patients knowing that not all patients who need care post-discharge will have the opportunity to go to a SNF.

Lastly, rural SNFs and hospitals should partner to focus on quality metrics, with specific attention paid to those that impact delivery system throughput, such as readmissions. This will help prevent further bottlenecks and strains on local hospitals. Use the Hospital Post-Acute Needs Diagnostic within our Post-Acute Care Pathways Explorer tool to see where hospitals in the geographic area are struggling.