Sicker patients, after less time spent in a hospital, are being diverted from a skilled nursing facility in favor of home care and hospice, according to recent analysis by care coordination software provider CarePort.

Discharge trends have resulted in a struggling occupancy rebound for SNFs, Martin said, with referred patients reportedly between 60 and 75% since last March — pre-COVID referral percentages were clocked at 106% in January 2020, by comparison.

Data caught a small number of patients going to home care that, based on 2019 models, would have gone to an SNF and stayed there long-term depending on comorbidity. These are residents aged 80 and higher, often with dementia and neurological disorders.

This group is being readmitted to the hospital at a 7% higher rate than the typical home health patient, Tom Martin, director of post-acute analytics for Boston, Mass-based CarePort, said during a webinar on Wednesday.

Martin presented findings at the WellSky webinar, alongside Sherry Thomas, director of clinical services for LeaderStat. While CarePort’s data is pulled from a smaller dataset and is not representative of the nation, it gives us more of a real-time look into occupancy and referral trends, Martin noted.

“I think that is a little bit of a trade-off that patients and hospital discharge partners need to consider,” said Martin. “This spike in-home health readmissions might suggest we’ve moved the needle too far, and sent too many people home that require skilled nursing.”

Hospital inpatient volume, on the other hand, has been rebuilt after a 30% drop during the first wave of COVID-19 last spring. When the second wave of infections occurred in the winter, the dip inpatient volume wasn’t as “dramatic,” Martin explained. Given this insight, he doesn’t expect a third delta variant-related wave to as heavily impact hospital patient volume, and in turn referral volume for post-acute care.

“We’ve seen fewer people going to SNFs. Is that the profile of a patient, the clinical profile of a patient in the hospital that has changed somehow fundamentally, or is it the decision process of the patient and the discharge planner?” Martin said.

The analyst used December as an example, pointing to 38% of patients for a particular health care system that was discharged to a nursing home during that time period.

CarePort had predicted that statistic to be 60%: “These patients, pre-COVID would have been very good candidates to go to skilled nursing. We would have thought, based off the patient’s acuity, they would have gone to skilled nursing but they are not.”

Instead, patients with middling acuity are being sent to home care, while those with higher comorbidities are being discharged to SNFs. CarePort has seen a 9% increase in the average comorbidity of patients, what Martin calls a “catch-all” for patients with multiple severe acuity diagnoses.

CarePort data also found the average length of stay in an acute care setting before discharge dropped by half a day, Martin added, before being discharged. This is compared to 2019.

The three-day inpatient hospital stay requirement for Medicare coverage was temporarily waived in March of last year to reserve beds for COVID patients.

Typically a patient would need to stay at the hospital for at least three days before they’re allowed to be discharged and still receive coverage under Medicare. June bipartisan legislation introduced in the House of Representatives aims to make the waiver permanent.

Image by Sabine van Erp from Pixabay