Changing Patient Population and Reimbursement Issues Challenge Skilled Nursing, Long-Term Care Providers

April 1, 2021
April 1, 2021

As healthcare evolves to become more competitive in terms of attracting and keeping patients, skilled nursing facilities and long-term care providers are having to adapt their business model in order to remain relevant.

One of the first challenges they face is staff recruitment and retention, especially as more avenues of care become available, such as private-duty nursing for the growing number of independent and franchised in-home care providers now in the market. In addition to high salaries, they can offer flexible work schedules that are appealing to nurses and other skilled workers.

Skilled-nursing and long-term care facilities also are demanding workplaces, which also leads to turnover. Their patients are increasingly more ill, which requires a much higher level of care and the accompanying skill set. They are often referred to as “mini hospitals,” because they increasingly are receiving patients who are discharged from acute-care facilities earlier and in worse condition than in the past. Those individuals still need significant care and can tax a facility’s resources when placed alongside more long-term residents who only require skilled nursing to continue living. That’s problematic when there is a general shortage of skilled nurses, because the ones a facility does have often must focus on a large number of tasks to be done vs. providing patient-focused, interactive care. They also know that penalties are being set into place for a facility’s role in preventing hospital readmissions, another worry.

Even so, the picture is not entirely bleak. Much as most nurses will say they got into the profession to help people, those in skilled or long-term care settings will report that helping the severely ill, who are often elderly, is their calling. An uptick in professional development for geriatric nursing in recent years has helped stabilize their ranks, but more educational opportunities are needed in order to ensure that nurses and skilled workers keep up with a senior population across the United States that is growing by the thousands every day.

Adapting to maintain strong service and differentiate from competition

As private-pay patients have more options, skilled and long-term facilities must compete to attract them, as a purely Medicaid patient census would be unlikely to cover all operating expenses. The elderly in particular are electing to remain home as long as possible, so they are not the source of revenue they once were.

The solution will revolve around finding a way to maintain appropriately trained staff, especially if a patient population is severely acute. While that is costly, it will greatly aid in efforts to reduce readmissions and also create a workplace that fosters collaboration and is appealing to potential patients and their families and/or healthcare decisionmakers.

At the same time, a change in the care mix is necessary. Adding the ability to provide physical, occupational, speech, and other therapies for both in- and outpatients will keep the patient census high, even as the bed count may shrink. This can be accomplished by filling out staffing rosters with nurse practitioners and physician assistants, especially those trained in geriatric care.

Attention also must be paid to the environment itself. If patients have left the hospital, for instance, they react well to visual cues that their new setting represents a positive change to their overall condition. That means a more home-like setting, including activities and events. In many cases, these adaptations resemble the scenario one finds in a step-down residential facility, where occupants can transition from fully independent living to assisted care and, in some cases, skilled care and even hospice.

The primary goal of any skilled nursing or long-term care facility should be to serve as a bridge both forward and backward in the patient-care continuum. Working closely with hospitals at discharge will help smooth the transition for patients who are improving, just as working with physicians and other community care providers to aid patients who need more care will create a more stable care environment. As with the preceding recommendations, this can be accomplished through a staffing change—namely, a transition team tasked with networking with all providers to assess a patient’s needs prior to intake, and then creating a care plan that can be implemented prior to his or her arrival vs. conducting triage once the patient is in house.

More than anything, skilled nursing and long-term care facilities can embrace their role as independent care providers, and work to create value for all patients, be they on-site for the long term, or for a shorter stay during their recuperative journey.

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