While Hospital Discharges to Home Health Rebound, SNFs See ‘Drastic and Lasting Decline’

The COVID-19 pandemic pummeled patient volumes across the health care continuum, but for skilled nursing facilities, the sharp decline in patients has not rebounded, according to a new analysis — even as hospitals and home health see their admissions recover.

Discharges to SNFs and to the home health setting fell in tandem with the decline in inpatient hospital volumes in spring, as elective surgeries were delayed or suspended in an attempt to preserve acute care capacity during the heights of the pandemic.

But while hospital discharges are steadily returning to their pre-pandemic levels, the “return to normal” is uneven across health care settings, Heather Flynn, a consultant at the Washington, D.C. -based consulting firm Avalere Health, noted in a recent update.


Avalere studied the relationship between lower hospital volumes and discharges to SNF and home health among Medicare fee-for-service (FFS) beneficiaries for two comparable time periods: January–July 2019 and January–July 2020.

The study found “a stark decline” in both inpatient hospital discharges and discharges to the SNF and home health settings starting in February of this year. But even though recovery for hospitals and home health began to pick up in late spring, the drop continued to hold steady for SNFs.

Source: Avalere Health

“The analysis further indicated that the skilled nursing industry has experienced a more drastic and lasting decline in patient volume relative to total hospital volume and discharges to home health (where rebounds were observed beginning in May),” Avalere observed.


One notable statistic centered on discharges to home health, which saw a year-over-year increase during June of this year, or a 4.6% greater discharge volume compared to June 2019.

Discharges to SNFs in June 2020, on the other hand, sat at levels 25.4% below what they were in June of 2019.

“As states aim to curb the spread of COVID-19 in institutional settings, patients may be more likely to be discharged home with home health or without post-acute care,” the update said. “The observed rebound in volume of discharges to home health suggests the potential to surpass pre-pandemic levels as the rebound in inpatient hospital volumes continues.”

Clear relief doesn’t appear to be in sight for SNFs, given that post-acute volumes could fluctuate depending on surges of COVID-19 in different parts of the country; some providers might not see a full return to normal volume for the rest of the year and into 2021, according to Avalere.

That said, post-acute volumes in general are likely to continue rebounding as elective surgeries resume and primary care services reopen.

“In the near team, lower than expected volume will put pressure on providers’ financial health,” the update said. “In the longer term, changes in care delivery broadly as a consequence of COVID-19 may influence how post-acute care is utilized following hospital discharge.”

The Avalere news came as the National Investment Center for Seniors Housing & Care (NIC) reported July skilled nursing occupancy at 74.6%, down from 84.7% in February and 84.0% in July 2019.

“Looking ahead as the Fall/Winter seasons approach, there is much uncertainty regarding occupancy with the potential of an acceleration in COVID-19 cases and the arrival of flu season,” NIC observed.

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