The Nursing Home Crisis Continues to Unfold

The president’s State of the Union address adds a sense of urgency to this crisis in America’s healthcare system.

Coming off another week working inside the hospital walls in my case management world, I have another topic to discuss related to President Biden’s initiatives – specifically, Biden’s pledge to provide the country with better nursing homes. I am sure we all remember the horrific news of elderly residents dying of COVID during our first wave of the pandemic. By the end of 2021, approximately 200,000 long-term care residents and staff members had died of COVID, which equates to nearly a quarter of all our COVID deaths thus far.

The focus on quality ratings and educating our communities on post-acute services had started before COVID, when the Centers for Medicare & Medicaid Services (CMS) began publicly reporting skilled nursing facilities’ (SNFs’) star ratings in late 2018. Then, in late 2019 came CMS’s ruling and updates for discharge planning requirements, to include quality measures or ratings as part of the patient choice process for post-acute placement. Under value-based arrangements, many hospitals and health systems started working in collaboratives across the continuum to elevate performance and help improve quality of care for their patients going to post-acute care. 

However, the level of mortality with COVID is requiring more muscle. The Biden Administration intends to conduct research this year regarding the minimum required staffing levels at nursing homes, and potentially roll out mandates for all facilities shortly thereafter.

CMS plans to require the phasing out of shared rooms, particularly addressing facilities that have three or more residents in a room. They are also planning to beef up their penalties, reporting requirements, and scrutiny of nursing homes, especially those that are owned by private equity firms. In fact, private equity firms that own poorly performing nursing homes could face significant penalties, including permanent legal implications.

The need to improve care for our elderly is dire. However, as we continue to face significant staffing shortages across hospital systems, I am unsure where the staff is going to come from for nursing homes. Patients often are sitting in hospitals waiting for days for a bed to open at a post-acute facility, because of limited staffing. With limited bed availability has also come an ample supply of patient referrals for top-choice facilities. The unintended consequence is that facilities can pick the best patients from the pile, which means that those who are more complex or underinsured sit in the hospital as unlikely candidates for placement.

Case managers are working with patients and families to send referrals out to outlying communities and across regions to see who is willing to accept a patient to free up a hospital bed. Often, the choices available for placement are not five-star facilities. Imagine the physician and case manager telling a family that they are ready to discharge a loved one to a two-star or one-star facility, because those are the only ones available that take their insurance and have a bed available. 

This is a conversation we have all too often. And thus, the patient and family naturally request to stay in the hospital, where they feel they will be safer and more cared for until another facility becomes available, or they can figure out how to go home and access home care services.

So today I ask, how many of you think that SNFs will be prepared to increase staffing ratios for patient care by the end of the year? For the results of the survey, click here.

Programming Note: Listen to Tiffany Ferguson’s live reports on SDoH Mondays on Monitor Mondays, 10 Eastern.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →