Skilled nursing facilities, and post-acute providers in general, will feel pain even beyond the immediate short-term challenges of protecting residents and staff from the spread of the novel coronavirus, several experts predicted Thursday.

The Centers for Medicare & Medicaid Services late on Wednesday recommended the delay of “all elective surgeries, non-essential medical, surgical, and dental procedures” during the COVID-19 outbreak, with the goal of reserving beds, ventilators and personal protective equipment.

That may have a trickle-down effect on providers that specialize in post-surgical rehab, Heather Flynn, a consultant with Avalere working with health plans and providers, said on the webinar.

That includes both SNFs and home health agencies, but for post-acute rehab facilities, there are some specific concerns, Fred Bentley, managing director at the Washington, D.C.-based Avalere, said on a webinar on Thursday.

“I’m wondering: What is the impact on volumes?” Bentley said on the webinar. “Now clearly these facilities are still open, and they’re going to be taking care of patients who have critical illnesses and need some level of care. However … the fact that we’re seeing hospitals and ambulatory surgery centers all suspending elective procedures — the reality is a lot of that elective volume then results in downstream admissions to a SNF, [or] a home health agency comes in.”

Skilled nursing operators in many markets looked to short-term rehabilitation services as the mode of the future, with one senior vice president at the real estate investment trust National Health Investors (NYSE: NHI) going so far as to describe rehab-heavy skilled nursing development as a “home run” in 2019.

Even outside of the short-term rehab world, there were pressures to lower patient length-of-stay in the SNF setting, and inpatient hospital stay declines were leading to a trickle-down effect where SNF admissions dropped.

So even though SNF providers need to be ready for an influx of non-coronavirus patients as hospitals try to free up what space they can to focus on emergency COVID-19 cases, a drop in elective procedures will still mean fewer patients that might come through their doors.

Given the uncertainty about how long the lockdowns and effects of COVID-19 will endure, it’s hard to say what the impact will be. But there is no question that SNFs will feel the change.

“Those are absolutely going to have significant effects on volumes for post-acute care providers,” Bentley said.

More broadly, the coronavirus may have a drastic effect on the future of the skilled nursing field, given that even before the outbreak, there was a trend of individuals wanting to age in place as much as possible, he added. COVID-19 is another issue that could “discourage folks from entering facilities,” Bentley said.

But for all that, in terms of the future of post-acute care, SNFs are not going to vanish.

“While it is true that [COVID-19] could discourage folks, or be one more powerful reason not to move to one of these facilities, the reality is that … home health is under a ton of strain now,” Bentley said. “So if these are individuals that are going to be staying at home, that obviously drives up demand for skilled and unskilled home care.”

Another major factor for SNFs to consider is infection control. A report from the Centers for Disease Control and Prevention (CDC) on the Seattle-area facility where the first major COVID-19 outbreak occurred indicated problems in this area, specifically in terms of staff members working with symptoms and pulling shifts at multiple facilities. Even before that report, infection control problems were widespread at SNFs across the country, according to a study from Kaiser Health News.

The implications for SNFs now — in terms of focusing on infection control, staff preparedness, and early detection — are significant, according to Bentley.

And the changes stemming from COVID-19 could even go beyond day-to-day procedure in the coming months and years.

“I also think there are going to be significant changes in facility design,” Bentley said. “New facilities that are coming online — how do you design them so that you do support social distancing while retaining the value of a communal setting?”

By Maggie Flynn | March 19, 2020

Skilled Nursing News