The skilled nursing industry is experiencing a profound shift in patient acuity, presenting both challenges and opportunities for operators.
Given this trend, experts at Skilled Nursing News’ RETHINK conference last week shared ideas on how to tackle rising acuity, including by creating “medical resorts,” using telehealth and predictive analytics to streamline care, creative staffing initiatives to reduce burdens as well as varied payment methods to improve reimbursement.
“We’ve seen acuity rise significantly over the last several years, with the Baby Boomer generation needing to take care of more people, we’re also seeing more complex diagnoses and health conditions,” Kristen Morris, chief clinical officer at Rockport, said. “We also have noticed trends and discharges from hospitals, where patients are in the hospital for a shorter amount of time, therefore, we are taking more complex types of patients.”
Along with Lori Strubbe, COO and partner at Focused Post Acute Care Partners, and Kimberly Green, COOat Diakonos Group, Morris shed light on how skilled nursing facilities (SNFs) can adapt their business models to thrive in this changing landscape.
Morris said that most notably due to the shift, patients now require care for chronic illnesses such as COPD, congestive heart failure, and diabetes, although the industry has also seen a rise in psychosocial and psychiatric conditions, including mental illness, homelessness, and substance abuse.
“We have to be more prepared to take the patients with those conditions,” she said. “So we definitely have seen that, especially in LA and the Bay Area in California.”
Addressing rising acuity with new care models
Kimberly Green discussed the concept of “medical resorts” as a response to changing post-Covid demands. She said Diakanos group opened medical resorts to offer a unique blend of inpatient rehabilitation and a comfortable, resort-like atmosphere.
“For us, [medical resorts] are just a brand name, however, it’s a super SNF,” she said. “It’s basically like an inpatient rehab facility, and a Hampton Inn combined.”
She said this approach caters to patients with higher acuity levels, ensuring they receive specialized care while enjoying an environment that feels less institutional. The resorts incorporate key services like piped-in oxygen and suctioning, full-time nurse practitioners, physician rounds, and specialized care for pain management and wound treatment.
Moreover, in line with the shifting acuity landscape, the Diakonos Group has invested heavily in data analytics and predictive modeling. By analyzing patient data and trends, they can proactively allocate resources, ensuring that higher-acuity patients receive the level of care they require without overburdening staff.
“We sold nine of our traditional long term care buildings, just so that we could open these medical resorts because they were $20 million each,” she said. “You know, what kind of you know, that’s very difficult in this, that because of the rising acuity, we knew that we had to do something differently, especially post-COVID.”
Policy changes for improved support
When it comes to addressing the financial aspects of rising acuity, the panelists expressed their desire for policy changes. Lori Strubbe called for a Medicaid rate increase in Texas and the implementation of specific payment plans for high-acuity cases, similar to Medicare.
“I would like for our I-SNPs providers to also take a look at carving out a specific payment plan for those higher acuity cases,” she said. “So we wouldn’t only collect the supplement that we did collect for all of our I-SNPs patients, but we would also be able to make up some of that cost when they do have to go to the hospital and don’t qualify for Medicare on that plan.”
Kimberly Green stressed the need for policy changes that focus on reimbursement for behavioral health and dementia care. Additionally, she highlighted the importance of incentives for facility updates and the adoption of new technologies.
“Neurocognitive patients, as we know, take more staffing to take care of them. If you’re really going to do it correctly, you know, when they begin to decompensate, you want to prevent that decompensation; you can’t allow it to happen,” she said.
Technology as a vital tool
The panelists discussed the role of technology in improving care outcomes for rising acuity patients. Green mentioned the value of telehealth and passive monitoring devices, such as telemetry, in higher-skilled facilities. She said these technologies allow for better monitoring of patients’ conditions, leading to more timely interventions.
“At any second, you have to have more staff,” she said. “So, we need to have some sort of policy change for that, as well as policy changes to help incentivize us as providers and owners to update our facilities and be able to have this new technology.”
In addition to passive monitoring, she said, the Diakonos Group has adopted cutting-edge medication dispensing systems that reduce errors and enhance medication management. These automated systems ensure that patients receive the correct medications at the right time, a critical factor in managing complex health conditions.
Lori Strubbe praised the use of real-time clinical monitoring systems and innovative tools for incontinence management, which she said enable SNFs to deliver higher-quality care and manage resources efficiently, including technology to monitor incontinence.
“This technology tells us when we need to be rounding,” she said. “As opposed to every two hours, we’re going in there to check, it tells us maybe you don’t need to go in there every two hours, maybe you just need to go in there every five hours, or maybe you need to go in there every 30 minutes. It really is individualized and specific for those residents. And so we’re super excited about that.”
Post Acute Care Certification Program
Morris, Chief Clinical Officer at Rockport, shared insights into the Post Acute Care Certification program implemented by her organization.
“We really identified their biggest challenge [was] the onboarding process and the level of skills that the nurses they were hiring wasn’t what it used to be five years ago,” she said. “Now, there’s a lot more orientation that needs to be involved.”
Recognizing the need for nurses to acquire advanced skills to handle rising acuity, Rockport introduced a three-day training and certification program. This initiative focuses on both theoretical and practical aspects of care, including disease processes, communication with physicians, and hands-on skills training. The program has empowered nurses to provide more specialized care, addressing the unique needs of high-acuity patients.
Furthermore, she said, Rockport has developed strong partnerships with local academic institutions to establish internships and apprenticeships for nursing students. This collaboration ensures a steady pipeline of skilled professionals who are well-prepared to care for patients with rising acuity levels.
“We’ve had over 250 nurses go through the training in 45 centers, and they’re begging for us to come back,” she said. “So, even though it was a challenge for them to, you know, kind of have an all hands on deck moment for three days, they did and it’s made a tremendous difference.”
Companies featured in this article:
Diakanos group, Focused Post Acute Care Partners, Rockport Healthcare Services
