Since the pandemic began, one thing has become abundantly apparent: There is a gap in the continuum of care for our nation’s most vulnerable patients.
All too often, medically complex patients aren’t ready to return to their home or living facility when Medicare or private insurance will no longer cover their hospital stay. This problem was compounded during the pandemic when CMS waived the three-day hospital stay requirement, forcing many patients into skilled nursing facilities that lacked the clinical capabilities to help patients fully recover. You can have the best care teams, but they can only do so much when they do not have the resources or tools to care for a broad spectrum of clinical needs.
The impact on nursing homes was summed up nicely in a recent article in the New England Journal of Medicine on “solving the nursing home crisis.” According to its authors, “COVID-19 has exposed the cracks in our tenuous system of providing and funding long-term care, and there are no easy fixes.”
During the past few months, our industry has seen many medically complex patients return to nursing facilities that were already overwhelmed by a pandemic. Transitional care facilities that adopted a more clinical, hospital-like setting well before COVID-19 were much better prepared. Elements such as physician-led care teams, highly clinical capabilities, in-house labs and on-site pharmacies, can allow facilities to accept hospital patients earlier than most typical skilled nursing facilities.
By investing in highly clinical, short-term care under a skilled nursing licensure, transitional care facilities can do the following:
- Treat individuals with complex medical needs separately from relatively healthy individuals,
- Isolate care teams who assist healthy individuals from those who treat more medically complex patients and are at higher-risk for COVID-19 complications,
- And reduce hospitalization readmission rates, as patients recover under a physician-led team.
In September, the Coronavirus Commission on Safety and Quality in Nursing Homes made recommendations for skilled nursing providers. This report includes 10 themes and highlighted “outdated infrastructure for many nursing home facilities.” What was absent from this report is the need for more transitional care operators and highly skilled clinical care. I encourage healthcare policy makers to take a more macro analysis and speak not just to skilled nursing providers, but hospitals as well. While skilled nursing facilities were hit hard, so were our hospitals, and those two are not mutually exclusive of each other.
To lessen the impact of COVID-19 on the skilled nursing industry and hospitals, we need more post-acute care providers that operate in a highly clinical setting. The line between skilled nursing and assisted living has blurred so much that those post-acute clinical settings can be difficult to find. A more segmented approach to care will help close the gap in the healthcare continuum.
Mark Fritz is president of Bridgemoor Transitional Care, which provides personalized, cost-effective transitional care in Texas following a hospital visit. Services are designed to enable patients to regain their highest level of independence as quickly as possible.