Although the COVID-19 pandemic is not over, it is not too early to see changes to senior care because of what was learned in 2020 and beyond.
“Over the last 19 months, COVID-19 has disrupted how care is sought and provided in all levels of care,” says Colleen O’Rourke, senior vice president of network and clinical solutions for naviHealth. “Regardless of setting, all healthcare institutions and providers have been stretched to their maximum to meet the needs of those most ill.”
In long-term care (LTC), case managers should note changes in occupancy and staffing at these facilities.
“Unfortunately, there have been close to 140,000 resident deaths in nursing homes due to COVID, representing approximately 11% of the nursing home population,” O’Rourke says.
In November 2021, the number of vaccinated LTC residents per facility hovered around 86.2% nationwide.1 But as of now, the effects of COVID-19 remain significant.
“Decreased occupancy due to resident death puts the LTC facilities at risk financially,” O’Rourke says. “LTC staffing shortages put the residents living in these facilities at risk for suboptimal care because skilled and non-skilled care hours decrease.”
Worry over nursing home placement remains “significant, resulting in many more patients, who would normally qualify for LTC, to remain at home with additional support of family or home health services,” she notes. Likewise, rehabilitation facilities were affected by the pandemic. Delivery of these services have had to adapt over the last nearly two years.
“Rehabilitation delivery has varied significantly in skilled nursing facilities over the course of the pandemic,” O’Rourke explains. “Initially, due to isolation, many residents were offered limited or modified therapy programs in their rooms instead of rehabilitation gyms. Some treatments were virtual — with a therapist on an iPad — and some treatments didn’t occur at all. All of these factors impacted a patient’s ability to make timely functional gains and discharge to home successfully.”
With both vaccinations and personal protective equipment largely available, rehabilitation gyms should reopen, especially considering the “practice of good infection control technique and cleaning schedules should allow service delivery in the most optimal environment,” she says.
Staffing issues remain a concern in many areas of the country. This can affect the quality of care.
“We are hearing, in some pockets of the country, that there is a shortage of rehabilitation professionals in [skilled nursing facilities],” said O’Rourke. “It is unclear if this is a direct result of the pandemic and therapists are leaving the workforce, or if it is related to the downsizing of rehabilitation departments in 2018-2019 when CMS reimbursement was no longer tied to therapy intensity. Regardless, rehabilitation is a critical component to a patient’s ability to recover from a hospitalization and return to the community. Skilled nursing facilities that accept patients for rehabilitation services must be able to provide the level of care and service a patient needs to recover timely.”
With many care facilities unable to accept as many patients as usual, case managers need to be more diligent in creating discharge plans.
“Case managers discharging patients to skilled nursing facilities must be acutely aware of the facility’s ability to meet the patient’s needs,” O’Rourke says. “Reputable [facilities] that are struggling with staffing levels or a COVID-19 crisis may decide to temporarily delay admissions to their facility. We should respect this decision, as it is in the best interest of current and future patients.”
For patients with complex needs, “Case managers should be comfortable seeking confirmation that the skilled nursing facility has the ability to care for the new patient,” she notes. “Further, it is perfectly acceptable to clearly outline the specific expectations for care in the referral and discharge documentation. During these challenging times, this extra diligence is a requirement and will help prevent readmissions and negative outcomes for patients.”
According to O’Rourke, these are several ways case managers can ease care transitions:
- Remaining open and honest with the patient and family throughout the process;
- Ensuring the patient’s needs can be met safely at home with support and/or services;
- Encouraging the families to tour a potential facility in advance;
- Considering staffing ratios, COVID-19 cases, admission protocols, and visitor policies at skilled nursing facilities;
- Empowering families to advocate on behalf of their loved one.
Recent Changes to Case Management Practices
Even as informal changes take place, there are other formal considerations for case managers to keep in mind as they work with senior patients during and post-COVID-19.
“First, COVID waivers for admission to skilled nursing facilities without authorization vary significantly from state to state and from health plan to health plan,” O’Rourke explains. “It is important for case managers to be up to date on policies and procedures that are specific to their region.”
Changes in skilled nursing facility admission practices are a second area in which case managers should be well-informed.
“Patients may require the first dose of the vaccination before entry,” O’Rourke says. “The facility may have tighter time frames for admission — day shift only or Monday through Friday — because of staffing or other issues, to avoid any backups of patients in the hospital. [Skilled nursing facilities] likely need a more coordinated effort.”
While the entire healthcare field has felt the reverberations of the COVID-19 pandemic, senior-focused facilities like long-term care, skilled nursing, and rehabilitation have been “hit particularly hard,” O’Rourke laments. Worst of all, these hits are personal for staff and residents.
“They have lost long-term care residents who they came to love and treat like family,” O’Rourke shares. “They have faced the most scrutiny from our federal government compared to any other care delivery provider. They were the first to have requirements for staff vaccination. They face an unprecedented staffing shortage. Yet, despite all of this, skilled nursing facilities’ dedicated professionals show up every day to take care of our moms, dads, grandmothers, and grandfathers with care and compassion.”
Case managers can follow the example of these patient healthcare providers. “Professional courtesy, grace, and empathy is needed,” O’Rourke says. “Teamwork and doing whatever is in the patient’s best interest has never been more important.”
REFERENCE
- Centers for Medicare & Medicaid Services. COVID-19 nursing home data. Updated Nov. 17, 2021.
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