Recent reports of hospitals keeping patients longer than predicted because of nursing home space shortages caused by the ongoing staffing crisis have stakeholders scrambling for solutions.
The phenomenon has had a domino effect. The first piece causing ripples on others is nursing home staffing shortages. As of August, nursing home employment was 10% lower than January 2020, just before the pandemic started to shake the planet.
That’s the worst labor recovery record of all the healthcare sectors, according to The Center for Health Workforce Studies.
“There’s no beds,” Rick Gundling, senior vice president of healthcare financial practices for the Healthcare Financial Management Association told Healthcare Dive. “Or no staff — even if there is a bed, there may be no staff. So hospitals can’t discharge.”
What’s to be done, short of bringing nursing home staffing levels up? Hospitals are losing margin on this, and nursing homes are hurt as well, said Erin Shvetzoff Hennessey, MA, CPG, NHA, CEO of consulting firm Health Dimensions Group.
“In addition to this causing capacity and financial challenges for hospitals, this loss of revenue to nursing homes, combined with rapidly increasing labor cost, results in serious operational sustainability concerns,” she told McKnight’s Long-Term Care.
Hennessey said there are no immediate solutions but plenty of angles of attack. She said the longer-term fix for adequate and sustainable nursing home bed availability must include higher reimbursement rates that can support higher wages to compete in the labor market.
“However, reimbursement and subsequent wage increases will take more time than overstressed healthcare systems and cash-strapped nursing home operators have,” she said. “To open up these bottlenecks, shorter-term solutions need to be used. These can include bed leasing models, at-risk payment models and collaboration/on-site support for more complex patients.
“We have seen great success when acute- and post-acute partners collaborate on this challenge with solutions that make sure everyone wins, especially the patient being in the right level of care.”
Some areas have localized aggravating factors. There are two additional complications in Illinois that worsen the bottleneck problem, Matt Hartman, executive director of the
Illinois Health Care Association told McKnight’s.
“Some components of our reimbursement are inextricably aligned with how staffing relates to the acuity of our residents,” Hartman said. “As well, we have a penalization system that has enormous fines associated with it which centers on a similar staffing acuity factor. With those two issues at play, in addition to a still recovering workforce nationwide, providers have to very carefully weigh when and how they can admit new residents.”
Hartman said the only real savior is for nursing home employment to catch up with the other sectors’ workforce rebounds.
“The last few months have seen steady upward growth in our workforce numbers, but we have a long way to go to see the return of pre-pandemic numbers,” he said. “To accelerate that recovery, we need to see additional investment in workforce by policymakers, including expanding educational opportunities, new visions for how we can create a viable career ladder for those interested in being a part of the profession, as well as financial investment.”