A leader from PACE program Summit Eldercare believes there should be at least half the number of nursing homes in the country, in order to adequately provide value-based care. Instead, prospective SNF residents would be better served in community housing options.
This is coupled with a trend Summit Eldercare is seeing among the SNFs it partners with — many are closing shop or not taking more residents due to the staffing shortage.
Around-the-clock home care delivered in community housing saves about $40,000 per person per year compared to a nursing home bed, Dr. Rob Schreiber, Summit ElderCare vice president and medical director, said during Home Health Care News’ FUTURE conference at the end of September.
“I really believe that if we had different [care] models, we could have at least half the number of nursing homes, and it would be less expensive for states, and for the federal government,” added Schreiber. “If you’re living in the community, living in your little home, you’re going to have better outcomes. You’re going to be more functional, you’re going to have relationships, you’re going to be more in control.”
Programs of All-Inclusive Care for the Elderly (PACE) is a Centers for Medicare & Medicaid Services (CMS) program aimed at providing interdisciplinary care with a team made up of clinicians with varying backgrounds; access to pharmacy services and behavioral health offerings is also part of the PACE program.
PACE providers also work with SNFs, hospitals, home care, visiting nurses and hospice, Schreiber said.
In order to participate in PACE, a patient has to be 55 or older, nursing home eligible and have at least two activities of daily living (ADLs) of need, Schreiber said. Participants don’t have to be dual-eligible for Medicare and Medicaid, but the vast majority are. An exception would be a Medicare eligible resident that also has a functional disability.
About 140 organizations provide PACE across 31 states, Schreiber said; Summit ElderCare is one of two PACE programs operated by Fallon Health, the other being Fallon Health Weinberg-PACE based in Western New York. Fallon Health is the eighth-largest PACE organization in the country, according to the National PACE Association.
Pandemic statistics put the program in the national spotlight, noted Schreiber, with COVID deaths in PACE populations being one-third of similar populations in nursing homes.
“We became overnight a home-based program not only to providers, but nurses, social workers, therapists and home health, meeting people where they’re at and being able to connect with them and make certain they were socially engaged,” said Schreiber, adding that this tactic led to less deaths.
Summit ElderCare does work with skilled nursing facilities too, although Schreiber admits they’ve lost a lot of SNF providers due to closures and topped-out occupancy.
“The SNF world, they’re struggling as it is. The ones that we are working with are filled up one, because of COVID, but we send them a lot of business, and the average length of stay has actually gone up because the people that we’re sending are sicker,” explained Schreiber.
SNFs are still a component of the larger health system, and care is based on the severity of a patient’s needs, a spokesperson for Fallon said in an email to SNN.
Prior to COVID, the number of admits to nursing homes was 570 per 1,000, what Schreiber says is a high rate; that statistic has decreased to 400 per 1,000 now.
“[Patients’] goals are not to live in a hospital the rest of their life, for most of the days or being in a nursing home. Their goals are to stay home and they’re willing to take risks, even if it means less life, but it’s better quality,” said Schreiber of the consumer-driven diversion away from SNFs. “We can customize care plans to meet them where they’re at.”
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