Pandemic-Driven SNF-to-Home Diversions May Become New Norm

Nursing home occupancy rates have plummeted during the COVID-19 pandemic, with hospitals, families and others opting for in-home care over institutional care settings.

And that trend may very well become permanent, recent data suggests.

Since the start of last spring, nursing home operators have faced fewer new admissions, particularly short-term rehabilitation patients. The growing number of empty beds paired with the high cost of personal protective equipment (PPE), testing and staff support is fueling financial losses, so much so that two-thirds of surveyed nursing home providers say they won’t last another year.


Not too long ago, there was a time when operators thought the second half of 2020 would bring a return to normalcy and an uptick in new admissions, the main source of income for any given nursing facility. But the coronavirus cases spreading like wildfire across much of the country toward the end of last year and in the beginning of 2021 has kept census figures at historic lows.

An analysis of post-acute referral patterns from care coordination software provider CarePort shows there’s little hope of that changing.

After falling to 69% of the previous year’s volume in April 2020, referrals to all post-acute care settings returned to 97% by October, according to the Boston-based CarePort, which pulled information from its discharge database of 390 acute-care organizations across 37 states.


As soon as June, home health agencies were running above their previous patient volumes, with referrals to the setting reaching 109% of 2019 totals by October. At the same time, skilled nursing facility (SNF) discharges had only crept back to 83% of historic volume.

“I won’t venture a guess on what that percentage is going to be, but I do not think we’re going to go back to 2019 normal completely,” Tom Martin, CarePort director of post-acute analytics, told HHCN sister publication Skilled Nursing News in early January.

CarePort’s analysis validates a growing narrative within both the skilled nursing and home health industries, Martin added.

“It looks like it’s plateaued, and I suspect we’re going to continue, over the next few months, to see that creep up,” he said. “But we’re still down 15% to 20% from what we saw in 2019 — and so it’s probably not surprising to anyone, but we are seeing that a lot of these patients that have typically gone to skilled nursing are now going to home health.”

On their end, most home health providers have embraced the newfound SNF-to-home diversion wave. Many have launched dedicated SNF-at-home programs that pair skilled home health services with non-medical home care capabilities.

To support those efforts, the National Association for Home Care & Hospice (NAHC) has even lobbied for reimbursement support.

“We have designed a [SNF-at-home] benefit to give individuals on the Medicare program the option of going home with expanded services,” NAHC President William A. Dombi said in October. “We think the design will work to be a win for the Medicare program as well. It’s been proven that you can provide less costly and high-quality care at home.”

During a year-end earnings call last week, Encompass Health Corp. (NYSE: EHC) executives described how they’re currently working on a SNF-at-home model with a handful of non-medical home care agencies. But the vision of a true “SNF-at-home” model still faces logistical hurdles, they explained.

“We are hopeful that there will be a version of SNF-at-home that actually makes it into legislation, and that there becomes a payer source for those private-duty services, acknowledging that we can likely provide that care to the certain cohort of patients at home less expensively than they would be cared for in a [SNF],” April Anthony, CEO of Encompass Health’s home health and hospice segment, said during the call. “But it’ll take more than the average $50-ish we get today out of Medicare to do that.”

Additional reporting by Alex Spanko.

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