Why Nursing Home Operators Should Borrow the Home Health Playbook When Rebuilding Census

In times past, the advice for improving census at skilled nursing facilities could generally be distilled to a data strategy. That data might range from statistics on difficult-to-place hospital patients to hard numbers around key outcomes such as readmissions to the acute setting.

But always the watchword was “data,” even if it wasn’t always clear where to find that information — or what a SNF should do with that information once it was obtained.

The post-COVID era is not like those times, as Mike Wetula, post-acute partnership strategist for Therapy Management Corporation (TMC), pointed out in a recent webinar.


“If I was presenting this webinar about a year, year and a half ago, I likely would have been discussing a data-driven, multi-step approach over time to build a sustainable referral partnership,” he said. “While that’s still a great option, a growing number of us are in search of a simplified approach that can be implemented quickly to increase referrals.”

As he noted, most SNFs are already using data to identify referral volume, diagnosis-based opportunities, and outcomes. That means going back to basics to identify what’s important to referral sources — especially given that home health providers are exceeding their pre-pandemic referral volumes and SNFs are experiencing consistent declines, Wetula said.

“Home health providers simply listened to the problems and responded with solutions,” he said. “They increase their clinical capability to provide care for higher acuity patients, and then promoted their SNF-at-home marketing strategy. They invested in new systems like mobile dialysis, and they also maximize the use of digital technology, embraced telehealth and expanded their ability to participate in these electronic referral platforms.”


This means that SNFs need to focus on identifying the issues faced by their referral sources and offering solutions, and the simplest way to do that is to talk with them, Wetula said.

He focused his presentation on three primary referral sources: hospitals, patients, and physicians.

For hospitals, Wetula emphasized the importance of calling up case managers to identify their needs. Some of the consistent comments from that source included recommending full usage of the hospital’s electronic referral system, and having a SNF profile that is complete and updated regularly in that system.

“The majority of the case managers told me that these facility profiles are the primary tool they share with their patients making decisions on which SNF to choose,” he said.

Other requests for SNFs from hospital case managers included a good response time, no “cherry-picking” of patients, multiple payer source options, and regular reporting of patient outcomes.

Wetula recommended several action items for SNFs to improve referral partnerships with case managers:

  • Setting up and updating the facility profile in the hospital’s system, complete with dedicating a person to ensuring the profile is updated regularly
  • Reviewing and identifying areas of opportunity in the electronic referral system’s facility scorecard; if such a tool exists, hospital case managers and decision-makers are regularly reviewing it, according to Wetula
  • If a SNF has an internal referral tracking system, using it to review the top three reasons why referrals do not convert to admissions
  • Creating a one-page report card with facility highlights and key outcome measures, for sharing with case managers

To target patients, Wetula recommended SNFs focus on learning what it is most important to patients who need rehabilitation and skilled nursing after a hospital stay. Action items here include making sure there’s a virtual tour option and ensuring cleanliness and strong infection control protocols — and knowing how other SNFs in the area compare on all the measures a patient might be considering.

Traditional physician partnerships also include sharing patient outcomes, but also providing physicians with clinical pathways and being aware of the physician’s protocols. Wetula also stressed the importance of an interdisciplinary team approach with policies to prevent hospital readmissions, and connecting physicians with the patient using virtual tools.

With home health’s share of referrals remaining steady or growing, it’s critical SNFs take steps now to start building their census back and making it as easy as possible to convert referrals to admissions, Wetula emphasized.

“Historically, skilled nursing providers could best care for high-acuity patients, but risk of exposure, isolation, and family visitation restrictions have muddied the waters,” he said. “Staffing and other limitations required everyone to become more efficient, which in turn quickly expanded our reliance on digital technology and remote options to provide care. Home health was already accustomed to working remotely, so this became very easy for them to adapt to.”

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