What Hospitals Consider When Pointing Patients to Skilled Nursing Facilities

Hospital patients only have a limited window of time to select a skilled nursing facility at discharge, and hospitals are increasingly looking at a few new metrics when deciding which SNFs to recommend.

In particular, hospitals are watching staff turnover rates more and more — even for executive positions, Vivage Senior Living chief business development officer Nancy Schwalm told Skilled Nursing News.

“Hospitals have figured out that if you have a stable staff, you have better care, so they look for low turnover rates and longevity of leadership,” she said. “I think it’s going to be more and more important to monitor, even though I know as an operator that it’s not always an easy fix.”


Stability among executive leaders at SNFs is important to hospitals because operations and best practices come from the top, so if there is different leadership every time an inspection is performed, it’s like starting from square one, Schwalm added.

Of course, hospitals also monitor expected credentials such as Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Ratings, hospital readmission rates, and other metrics such as pain management, fall prevention, and infection control — but their standards have gotten higher in recent years, according to Schwalm.

“Many health care systems have gotten more selective and are doing more careful vetting,” Schwalm said. “Particularly some of the larger hospitals have requested information from SNFs to make sure that they can recommend them based on metrics. A hospital in the Denver metropolitan area that used to recommend around 80 facilities now only lists about 20.”


High rankings in these areas are what matters most to hospitals, while they also look at added amenities like private rooms, concierge services, and Wi-Fi access, Schwalm said. But the added bonuses are ultimately just that: A hospital’s final decision to recommend a SNF is not based on those in her experience.

“Every hospital that has chosen to recommend Vivage has done so for evidence-based reasons,” said Schwalm, whose Lakewood, Colo.-based company has skilled nursing facilities in Colorado and Missouri. “It’s not they they like us better or we have prettier facilities.”

More careful monitoring of SNFs by hospitals, as well as increased assistance in helping discharged patients choose the SNFs that best suit their needs, is in the best interest of hospitals as well as incoming residents, Schwalm said. As hospitals work to meet their own operational goals, quality care from SNFs works in their favor.

“Hospitals are increasingly recognizing the value that post-acute and long-term care facilities bring,” Schwalm said. “They’re trying to get people out of the hospitals quicker as a part of their requirements to control costs and ensure quality care, and prevent them from returning to the emergency room. Continuum of care is important and valued.”

Written by Elizabeth Jakaitis

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