The Nursing Home Crisis Continues to Unfold

The president’s State of the Union address adds a sense of urgency to this crisis in America’s healthcare system.

Coming off another week working inside the hospital walls in my case management world, I have another topic to discuss related to President Biden’s initiatives – specifically, Biden’s pledge to provide the country with better nursing homes. I am sure we all remember the horrific news of elderly residents dying of COVID during our first wave of the pandemic. By the end of 2021, approximately 200,000 long-term care residents and staff members had died of COVID, which equates to nearly a quarter of all our COVID deaths thus far.

The focus on quality ratings and educating our communities on post-acute services had started before COVID, when the Centers for Medicare & Medicaid Services (CMS) began publicly reporting skilled nursing facilities’ (SNFs’) star ratings in late 2018. Then, in late 2019 came CMS’s ruling and updates for discharge planning requirements, to include quality measures or ratings as part of the patient choice process for post-acute placement. Under value-based arrangements, many hospitals and health systems started working in collaboratives across the continuum to elevate performance and help improve quality of care for their patients going to post-acute care. 

However, the level of mortality with COVID is requiring more muscle. The Biden Administration intends to conduct research this year regarding the minimum required staffing levels at nursing homes, and potentially roll out mandates for all facilities shortly thereafter.

CMS plans to require the phasing out of shared rooms, particularly addressing facilities that have three or more residents in a room. They are also planning to beef up their penalties, reporting requirements, and scrutiny of nursing homes, especially those that are owned by private equity firms. In fact, private equity firms that own poorly performing nursing homes could face significant penalties, including permanent legal implications.

The need to improve care for our elderly is dire. However, as we continue to face significant staffing shortages across hospital systems, I am unsure where the staff is going to come from for nursing homes. Patients often are sitting in hospitals waiting for days for a bed to open at a post-acute facility, because of limited staffing. With limited bed availability has also come an ample supply of patient referrals for top-choice facilities. The unintended consequence is that facilities can pick the best patients from the pile, which means that those who are more complex or underinsured sit in the hospital as unlikely candidates for placement.

Case managers are working with patients and families to send referrals out to outlying communities and across regions to see who is willing to accept a patient to free up a hospital bed. Often, the choices available for placement are not five-star facilities. Imagine the physician and case manager telling a family that they are ready to discharge a loved one to a two-star or one-star facility, because those are the only ones available that take their insurance and have a bed available. 

This is a conversation we have all too often. And thus, the patient and family naturally request to stay in the hospital, where they feel they will be safer and more cared for until another facility becomes available, or they can figure out how to go home and access home care services.

So today I ask, how many of you think that SNFs will be prepared to increase staffing ratios for patient care by the end of the year? For the results of the survey, click here.

Programming Note: Listen to Tiffany Ferguson’s live reports on SDoH Mondays on Monitor Mondays, 10 Eastern.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

The Inpatient Admission Order: Master the Who, When, and How

The Inpatient Admission Order: Master the Who, When, and How

During this webcast Dr. Ronald Hirsch delves into the inpatient admission order process including when to get it, when it becomes effective, its impact on billing and payment, who can write it, how to cancel it, the effects on the beneficiary, and more. You’ll leave with a clear understanding of inpatient orders and guidelines for handling improper orders that you can implement immediately.

June 20, 2024
Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Michelle Wieczorek explores challenges, strategies, and best practices to AI implementation and ongoing monitoring in the middle revenue cycle through real-world use cases. She addresses critical issues such as the validation of AI algorithms, the importance of human validation in machine learning, and the delineation of responsibilities between buyers and vendors.

May 21, 2024
Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your inpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. Participants will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

June 26, 2024
Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P., as she helps you navigate advanced inpatient CDI technologies, regulatory changes, and system interoperability. Angela will provide actionable strategies for integrating AI and predictive analytics into CDI practices, ensuring seamless system interoperability, and maintaining compliance with evolving regulations. Attendees will learn to select and implement advanced EHR systems and CDI software, leverage data analytics to enhance documentation accuracy, and stay audit-ready with the latest compliance updates. Real-world case studies and practical tools will empower you to drive continuous improvement in CDI, improve patient outcomes, and enhance organizational efficiency. Don’t miss this opportunity to advance your CDI practices and stay ahead in this dynamic field.

July 11, 2024
Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P, for an insightful webcast on improving inpatient clinical documentation integrity (CDI). Inaccurate documentation can lead to misdiagnosis, improper treatment, and compromised patient safety. High workloads, lack of standardized practices, and outdated EHR systems contribute to these issues, affecting care quality and financial outcomes. Angela will offer practical strategies and tools to enhance accuracy, consistency, and timeliness in documentation. Attendees will learn to use standardized templates, checklists, and advanced EHR systems, while staying compliant with regulations. Improve patient care, ensure accurate billing, and reduce audit risks with actionable insights from this essential webcast.

June 26, 2024
Mastering E/M Coding: Navigating the Evolving Landscape

Mastering E/M Coding: Navigating the Evolving Landscape

Join industry expert, Kathy Pride, RHIT, CPC, CPMA, CCS-P, for an in-depth exploration of Evaluation and Management (E/M) coding, tailored for healthcare professionals navigating recent guideline changes. Dive into advanced topics beyond mere code selection, including shared visits, criteria for selecting E/M levels, and documentation best practices. Gain clarity on complex guideline terminology and ensure compliance with regulatory standards. This comprehensive session is essential for coders, auditors, educators, and practitioners seeking to enhance their proficiency in E/M coding and maximize revenue capture.

June 19, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

Honor Memorial Day with Savings! Get 20% off all items using code MEMORIAL24 at checkout. Shop today and save! Offer valid until May 31. Exclusions apply.

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.