Skilled Nursing Providers Struggle to Meet Referral Demand Amid Staffing Crunch

After months of wondering if hospital referrals would ever rebound during the height of the pandemic, skilled nursing operators now face a new problem.

Worsening staffing shortages have left many operators unable to meet current patient demand.

That’s according to a new report from CarePort, a WellSky company. The report examines data from more than 1,000 hospitals and 130,000 post-acute care providers and focuses on how the COVID-19 emergency has impacted care delivery.


Hospitals are experiencing challenges identifying SNFs that are able to accept their patients as unprecedented staffing shortages continue to limit SNF capacity, the report said.

Skilled nursing facilities are declining referrals 10% more often than they did before the pandemic. The SNF rejection rate in 2021 was 57%, compared to 52% in 2019.

The rejection rate has continued to climb — reaching 65% in January of this year, according to CarePort.


Total staffing hours in nursing homes were also affected over this time period, decreasing by 37 hours between April 2020 and April 2021.

“The industry must continue to solve for current challenges and usher in a new era of healthcare – one that is connected, collaborative, and focused on achieving the best possible outcomes,” CarePort Founder and CEO Lissy Hu said in a news release.

As a result of these staffing limitations, the average hospital length of stay for patients in the CarePort network being referred to SNFs has increased by 10% since 2019.

While hospital inpatient volume has returned to pre-COVID-19 pandemic levels, there have been noticeable changes in patient acuity and discharge destination.

Patients discharged to nursing homes and home health are more acute than they were prior to the pandemic, according to CarePort, with an average comorbidity increase score of 11%. Common comorbidities include congestive heart failure, chronic obstructive pulmonary disease, hypertension, neurological disorders and diabetes.

In recent years, some providers have positioned themselves to take on more complex patients with some investing in in-house dialysis as a way to draw in new patients from hospitals.

Brickyard Healthcare – a SNF provider with 23 locations throughout Indiana – recently partnered with Fresenius Medical Care to bring in-house dialysis to some of its buildings and is already seeing the benefits pay off.

“We’ve been doing that in one of our care centers in Indianapolis and that’s been a good niche for us with all the challenges that existed with transportation back and forth to dialysis,” he previously told SNN.

Others like SavaSeniorCare and Odd Fellow Home have looked to do the same.

“On average, higher acuity patients have a greater need for services post-discharge, adding increased complexity to getting that patient the care they need,” Hu said.

And in what appears to be a continually growing trend, home health referrals reached 116% of 2019 totals by March 2021, as discharge planning teams, patients, and their families are increasingly opting for home-based care over institutional care settings such as nursing homes.

Of the overall patient referrals, 60% comprised home health and 40% were sent to nursing homes.

Beginning in April 2020, actual SNF discharge rates lagged far behind predicted SNF discharge rates, indicating that patients who normally would have been discharged to a SNF were instead discharged to home health care as the need to carefully coordinate patient care in the home is expected to only continue to grow.

Companies featured in this article: