When PruittHealth — a major nursing home operator — began to see its skilled nursing facilities (SNFs) feel the impact of the COVID-19 emergency last year, the company was able to promptly bounce back by throwing its weight behind home health care.
Norcross, Georgia-based PruittHealth is a post-acute and long-term care operator that has over 180 locations across Florida and Georgia, plus North and South Carolina. Along with its skilled nursing and assisted living properties, the company offers home health and hospice care while likewise maintaining robust pharmacy business lines.
Since last spring, the public health emergency has taken a considerable toll on SNFs and other long-term care facilities.
Roughly, 170,000 nursing home residents have died as a result of the COVID-19 virus, according to data from Kaiser Family Foundation. This includes nursing homes and other facility-based long-term care settings.
As COVID-19 cases ran rampant throughout facilities, operators saw occupancy flatline.
When looking at SNF occupancy trends across 48 states, none reported a rate higher than 80% in 2020, according to data analysis conducted by professional services firm CliftonLarsonAllen. New York had the highest occupancy rate, at 79%. Texas had the lowest SNF occupancy rate, at 56%.
Like most of its peers, PruittHealth wasn’t immune to the industry-wide woes.
During the pandemic period, PruittHealth saw an 18.5% decrease in SNF admissions and experienced a $137.2 million revenue hit, according to the company. The revenue loss included the company’s skilled nursing, therapy, pharmacy and hospice business lines.
Additionally, about 1,900 PruittHealth employees and 5,174 residents were diagnosed with COVID-19 last year.
As a response to those challenges, the company decided to aggressively lean into its “PruittHealth at Home” business, PruittHealth CEO Neil Pruitt, Jr., told Home Health Care News.
“We knew this pandemic was affecting our service lines and that we needed to be creative and in how we provided care,” Pruitt said. “We knew that even if we weren’t able to admit patients into our skilled nursing facility for whatever reason — if we didn’t have the staffing, if there was an outbreak in the facility, etc. — we still had to meet the needs of those patients.”
‘Actively pursuing the at-home option’
PruittHealth remains dedicated to its in-home focus as COVID-19 numbers are rapidly dropping at nursing homes, largely because of vaccine disruption. Weekly COVID-19 cases at SNFs have decreased by 96% since vaccinations began, from about 34,000 per week to less than 1,500 per week.
In order to pull off the pivot to home, PruittHealth brought in global consulting firm Accenture to work with its home health service line. The company’s goal was to expand the breadth and services of this part of the business and ensure it had the ability to meet increasing demands.
Subsequently, PruittHealth decided to transform the 800-car parking lot at its corporate headquarters into a state-of-the-art medical supply facility, since the majority of the company’s workforce was now remote.
That gave PruittHealth the ability to send medical supplies directly to a patient’s home. The company also leveraged its pharmacy capabilities to send patients’ medications into their homes to help maintain adherence, a key driver of hospital readmissions.
“Whether someone wanted to bypass the SNF altogether, or if they wanted to compress their stay, we had a way to continue to care at home,” Pruitt said. “We have been actively pursuing the at-home option, and are seeing success and a lot of satisfaction from our patients.”
Indeed, PruittHealth has experienced a 22% spike in its home health care census.
“We’ve long been an advocate of serving people in their home when appropriate,” Pruitt said. “It’s kind of ironic because people think of us as a nursing home company, but in our biggest state (Georgia) we serve more people in the community than we do in our facility.”
In Georgia, the company has been able to do this through Georgia SOURCE, a Medicaid waivers program that manages care for nursing home eligible patients in their home.
Pruitt believes there will always be a demand for SNFs, but he stressed the importance of adapting to patients’ needs.
“We’ve always discharged about 60% to 70% of our patients to the home,” he said. “And so we’re just extending those services to them and the community.”
Another senior care company, United Church Homes (UCH), is similarly working to expand its care delivery model and add home-based care services to its arsenal of offerings.
UCH is a Marion, Ohio-based nonprofit independent and assisted living operator. The company has 75 communities in 14 states.
In recent years, UCH has reported seeing “just a fraction of the number” of referrals from hospitals.
“It’s more cost-effective to [provide] home care, rehab and health care services to the residents [in their homes],” Senior Vice President of Finance and Strategy John Renner recently told Senior Housing News.
In 2020, UCH experienced a $7 million total decrease in its revenue stream. As a result, the company began looking into what services they could provide in the home setting.
“At this time, [UCH] is basically sustaining its long-term care and nursing home programs,” Renner told SHN. “But our future is in what we call older adult residential communities and care planning, outside the walls of a community structure. We’re [implementing this in] two fronts: We’re expanding our independent living or residential programs for seniors. We’re also expanding programs to service their personal as well as health care needs, while they’re still in home, aging in place.”
One lesson providers should take away from the current time is the importance of “site-agnostic care,” Pruitt noted. Providers that can quickly adapt between settings will see the most success in the future, he explained.
“Not many companies can do what we do,” Pruitt said. “Not many companies can say, ‘If you need skilled nursing facility services, we can help you. We can keep that stay as short as possible, then discharge into the home.’ I think that will be the trend of the future and companies will try to put it together.”