Solutions Forged in Crisis Provide Glimpse of Future SNF, Hospital Alignment

If the latest COVID-19 variant has revealed anything about the care continuum, it’s that temporary solutions to solve the capacity crisis could have long-term implications on the way SNFs and hospitals can better align moving forward.

In Pennsylvania, Gov. Tom Wolf set up long-term care regional support sites to help decompress the health care system with COVID-19 hospitalizations reaching historically high levels.

Pennsylvania Health Care Association President and CEO Zach Shamberg said the move will open up about 30 beds per regional support site, set up at four long-term care facilities in the state for a total of 120 beds. The move was the governor’s latest step in a multi-layered approach to alleviate pressures on health care workers and facilities.

“I think the relationship between hospitals and nursing homes has been strained since the start of the pandemic,” Shamberg said. “The reason that hospitals can’t discharge today is because the number one referral source is long-term care and long-term care providers cannot accept new residents because they don’t have enough staff.”

In Michigan, a new post-acute care facility was recently established through a joint venture between a local hospital and nursing home that offers transitional care to post-operative patients. These kinds of transitional care communities may serve to fill a gap in the care continuum long-term.

Nursing homes saw a notable slowdown in move-ins to start 2022, according to the latest National Investment Center for Seniors Housing & Care (NIC) Executive Insights survey, similarly to the delta surge.

As Janet Tomcavage, executive vice president and chief nurse executive at Pennsylvania-based health system Geisinger, explained, the omicron wave has been as disruptive to care as any of the previous waves.

“Three or four weeks ago, we counted the number of beds that have nursing home patients in them that are ready and stable for discharge and it was about 120,” she adeed.

Support sites filling gaps in care

The Pennsylvania governor’s initiative is not the first time hospitals have looked to long-term care for help during the pandemic and vice versa.

“We actually were on a call with one of our nursing home partners that have three or four facilities in our network and we were talking with them about how do we help you create beds that take care of higher risk patients that are long termers: stable vent patients, complex wounds, multiple antibiotics, those sort of things,” Tomcavage said. “What would it take for you to feel confident to take those patients so that it freed up hospital beds.”

She said her SNF partners were very open to the idea and she was looking at how to leverage telehealth and at-home services to take care of higher acuity patients.

“We’ve always worked to try and have collaborative relationships with our long-term care facilities,” Tomcavage said.

As such, Geisinger sends about 20 advanced practitioners out to work full-time in independently owned nursing homes in the area, according to Tomcavage.

“Those are the facilities that we send a lot of our patients to for post-acute care. We are often medical directors in many nursing facilities and I think Geisinger has worked hard in our post-acute network to create relationships with them because we know they’re important,” she added.

However, with the hospital system dealing with a current vacancy rate of 40% for its staff, Geisinger has utilized smaller, less staff intensive units to transfer patients who are clinically stable and awaiting a nursing home bed.

SNFs figuring out ‘what else’ they can do

For Evangelical Lutheran Good Samaritan Society, strengthening their relationships with their hospital partners began well before the pandemic, through a merger with Sanford Health.

The faith-based nonprofit organization partnered with Sanford to open major hubs in North Dakota, the home state for both organizations, to provide a fully integrated model of care.

“I think our ability as one system now today really does create some unique differentiation within the industry,” CEO Nathan Schema told Skilled Nursing News. “If we’re having hospital capacity issues up in Fargo, the CEO can pick up the phone and give me a call, and we can get working on it that day.”

Clear and constant communication with Sanford has helped Good Sam come up with creative solutions when they are needed most.

The organization opened temporary alternative care sites, including one in Arthur, North Dakota, out of an assisted living facility, as a way to alleviate overburdened hospitals.

“We saw our hospital partners struggling and we asked what else can we do to help,” Schema said.

He said he was able to bring in nurses from all over the country to “make it work.”

“In some places they have gotten creative and filled up what used to be the activity room, there’s been a lot of special care units or dementia care units that for us, maybe have the same use or purpose that they once did so those were used to transition COVID patients from hospitals,” Schema added.