Focus on long-stay rates

Steven Littlehale
Steven Littlehale

By now, everyone has heard the resounding drumbeat of 30-day rehospitalization rates. What is yours? Are you improving? Are you using the National Quality Forum's endorsed method for calculating? 

You should also be hearing the distant thunder of what is steadily approaching … evaluating how you manage the care of your long-stay population. 

Depending on your market, you may be considering participation in a bundle, an I-SNP, or managed Medicaid. Regardless, the long-stay population has specific needs. These residents tend to have more chronic physical and mental health illnesses and infections. Driving down rates of hospitalization (notice we're not talking about rehospitalization) not only supports quality of life, but also lowers healthcare costs.

Similar to short-stay residents, payers are seeking providers who perform the best in preventing unnecessary hospitalizations. 

Following the Centers for Medicare & Medicaid Services' Quality Measures definition, residents who stay in a skilled nursing facility for more than 100 cumulative days are designated as “long-stay.”  Our research indicates that the average facility's long-stay hospitalization rate is 14.7% unadjusted and 13.8% adjusted. These are averages. There is room for improvement, but some are doing well!    

Before the thunder gets much closer, SNFs should consider how they can best provide care to this population and lower their rate below 14.7%.

Individualized care plans are essential. The focus should be on progression of chronic illness and resident/family expectations — with advance directives as one recommendation. In our study of 14,990 long-stay residents, approximately 8.5% sent to the hospital were at end of life. 

Predictive analytics is an excellent way to help identify these frail residents to start the referral process if appropriate. Frank and open conversations about the perceived benefits, risks around hospitalizations and residents' wishes lead to the best possible outcomes for this population.

Steven Littlehale is a gerontological clinical nurse specialist and former university instructor.