A recent study from University of Pennsylvania researchers reveals that among 975,179 hospital discharges who were 65 years or older, the use of skilled nursing facilities (SNFs) noticeably declined over the course of the pandemic. SNF spending within post-acute care was also shown to have declined.
As hospitalizations declined in March and April 2020, so did the rate of post-acute care use per 100,000 enrollees.
These rates rebounded to 72% of the pre-pandemic rate by October 2020 for home health and to 78% for inpatient rehabilitation. The rate of SNF use did not rebound as quickly.
Featured in the Journal of the American Medical Directors Association, the Pennsylvania study showed SNF use declined from an average of 324 SNF admissions per 100,000 enrollees in 2019 to 167 SNF admissions per 100,000 by October 2020, or 51% of the pre-pandemic rate.
Total spending for each of the three post-acute care locations also declined, with SNF spending declining the most.
“SNF spending declined from an average of $42 million per month in 2019 to $19 million in October 2020, a 55% decline,” the researchers wrote. “When examining spending in each post-acute care location as a percentage of all post-acute care spending, we found that spending shifted away from SNFs and toward home health and inpatient rehabilitation.”
SNFs’ percentage of post-acute care spending declined from 39% when the pandemic first started to 31% in October 2020 while the percentage of home health and inpatient rehabilitation spending within post-acute care both increased. A larger portion of post-hospital discharge care was delivered at home through the pandemic, matching current patient preferences.
Researchers said that reducing SNF utilization has been a common target to reduce health care spending through the pandemic as concerns over COVID-19 rates in nursing homes likely accelerated this trend.
They added that the push to home care may also shift the burden to family members and other unpaid caregivers, and expressed concern that it may result in less quality care.
“There is increasing concern that beyond limitations in the level of help for activities of daily living, current models of home-based care may also provide insufficient medical care to care for ill patients recovering from hospitalization,” the researchers said.
The declined utilization and decreased spending of SNFs may also lead to big shifts in the skilled nursing sector itself.
“The decline in SNF admissions may hasten a change in the role of nursing homes, causing nursing homes to focus more on long-term care as post-acute care admissions decline,” the researchers added.
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Journal of the American Medical Directors Association, University of Pennsylvania
