Clinical speciality services are growing within nursing homes to address needs of a population with higher acuity – but there are some sizable side benefits to this trend.
Operators and other community institutions are working to accommodate the need for certain types of care in the nursing home through partnerships. Not only are nursing home operators seeking to partner with ancillary providers as an education tool for its clinical staff, but nurses from state universities and community colleges are graduating with more knowledge of specialties to meet higher acuity across the care continuum.
Such partnerships have mutual benefits for both ancillary service providers and educational institutions as well as the SNF industry. For nursing homes, they are able to maintain a more stable workforce and census while also cutting back on unplanned discharges to hospitals – in some cases as much as by half.
This is especially true in rural areas of the country where a nurse often needs to be more of a jack of all trades in terms of clinical capabilities, especially as the labor shortage is felt stronger in these areas.
“The availability of specialists in SNFs can vary depending on geographical location, resources, and the specific needs of the resident population. In some cases, access to specialists may be limited, particularly in rural or underserved areas,” said Shawn Neville, COO for SALMON Health and Retirement.
Hospitals also fill the clinical specialty pipeline for nursing homes, with many getting paid across provider lines or as community providers of such specialties, according to Jennifer Hertzog, vice president of marketing and business development for Marquis Health Consulting Services.
Cheri Kauset, vice president of business development for Mission Health Communities, says they started to see the need for “another layer of expertise” a few years ago, heavily based on the types of patients being discharged from the hospital.
A need for hemodialysis services at a facility in Minnesota – where Mission Health has its largest community, for example, spurred an influx of nurses specializing in kidney disease through a partnership with DaVita, Kauset said.
“We worked with the local hospital along with DaVita kidney care, and we put in an in-house hemodialysis unit that currently has six chairs. We’re adding three more,” Kauset said.
Not only was Mission Health helping patients transitioning from the hospital, but also helping existing residents that would have normally had to leave the building to receive dialysis care.
DaVita nurses trained Mission Health nurses too as part of this partnership, she said, and as a result they have been able to step up such resources for the surrounding community.
“We were doing very, very well, not only with supporting a more stable census, but our unplanned discharges back to the hospital were actually cut in half for our own patients. It was really pretty remarkable,” added Kauset.
DaVita nurses are still employees of DaVita, Kauset said, but the amount of cross-trained staff from the partnership has helped Mission’s specialist pipeline.
“[Residents are] staying in, and then our pipeline with our nurses and our education that we’ve been able to provide through DaVita, we’ve been able to really make sure that folks stay stable and maintain that level of comfort inside our own community,” added Kauset.
College curriculum and the specialist pipeline
Rural community colleges and state universities located in rural parts of the country are shifting their curriculum, or so it seems, with graduates being able to handle more acuity on the floor.
The geriatric population has generated more conversations and resulted in it becoming a more prominent part of the nursing curriculum going forward, Kauset said. However, there’s still room for more, and she’d like to see these conversations become even more common place.
“It’s happening in pockets. In Kansas, we are a part of those conversations, but in some of our other states, not so much,” said Kauset. “I think that there’s definitely work to be done there, from a strategy perspective and population health.”
For Mission Health, particular specialities have fallen under kidney care, dialysis, respiratory care and chronic disease management.
“I’m sure Covid inspired a lot of that. Nurses are coming to us with a little bit more,” she said.
Meanwhile for SALMON, Neville said speciality partnerships with schools can take other forms as well, including joint research projects, training programs, internships and continuing education opportunities. Sharing knowledge, developing evidence-based practices and creating specialized curricula are all ways a partnership can develop, he said.
Once these new nurses start their career in a SNF, it’s up to the industry to meet these graduates at their level through continuing education for other team members, including certified nursing assistants (CNAs) and certified medication aides (CMAs), along with restorative nursing assistants.
And it seems that nurses with specialized training are getting absorbed into the workforce.
“We’ve added a level of education that would make sense, whether it’s respiratory care, whether it’s infection control, whether it’s support in our dialysis units,” noted Kauset.
To that end, Mission Health has partnered with therapy vendor Encore for its trach dialysis unit. Similar to DaVita, Encore is another strategic relationship which involves staff training – making sure in-house nurses are up to speed on what is needed for these types of patients, she said.
These partnerships could be considered a retention tactic for operators too, and an aspect of company culture as they supporting new nurses to work at the top of their license and employ the specialist knowledge they picked up in school. Moreover, it gives nursing homes a competitive edge as hospitals are looking for the same nurses.
“If someone comes in with a skill set, we want them to retain that skill set,” added Kauset. “We’re also making sure that our CNAs and restorative folks are also up to speed on what they can do within their scope to help support those higher clinical needs for the patients, but also keeping our nurses not feeling that they have to do it all, that there are people there with a special education that can help support what’s going, what needs to happen throughout the shift, throughout the day.”
Marquis’ speciality directorship likely helps with recruiting and retention too. Focused program directors are often also the pulmonologist, nephrologist or other speciality provider administering care at the bedside, Hertzog said.
The thought leader and specialist providing care are one and the same, she said, because one role informs the other and leads to better care outcomes.
Staffing pipeline and the hospital bottleneck
Marquis has for the past few years focused on nephrology, pulmonology, cardiology, pastoral, palliative and infectious disease specialists, as a way to address the needs of its hospital partners.
A lot of its speciality programs – which can fall in line with what hospitals are seeing – would not have been possible without the ability and willingness to invest in specialists and building out a staffing pipeline that supports Marquis’ ability to do very advanced and progressive services for its residents.
“That’s been our focus,” said Hertzog. “It has enabled us to do things like launch certification of heart failure by the American Heart Association; they have roughly 80 facilities across the country that are heart failure certified by their terms and criteria. Marquis has 25 of the 80.”
In a world of 15,000 nursing homes, where nationally less than 1% are certified by the American Heart Association, Marquis has about one-third of those certified buildings.
Mission’s business development teams are meeting this need, going in and talking with hospital partners about trends, and how local SNF operators can help.
“It really was the local hospital system saying, ‘this is what we see. We have a lot of folks here that need dialysis, or may need respiratory care with dialysis. What can you do for us?’ And that’s how we really started to segment where we needed to go next,” said Kauset.
A clinical specialist pipeline can help with transitions in care too, Neville added. The right specialists – depending on the community – can facilitate a timely discharge and allow specialized care to be seamless from one care setting to another.
“Collaboration ensures that the senior care setting has the necessary resources and expertise to meet the patient’s specific needs,” noted Neville. “When these partnerships function effectively, patients can experience smoother transitions from hospital to appropriate senior care settings, reducing the length of hospital stays and improving overall care continuity.”
But, it’s important to take specialists into account when discussing ongoing partnership evaluation and feedback, Neville said. Continually assessing specialist involvement and coordination of care could help with overall outcomes.
Companies featured in this article:
Marquis Health Consulting Services, Mission Health Communities, Salmon Health and Retirement
