Even as it changes from pandemic to endemic, the effects of Covid-19 are still being keenly felt by many post-acute care facilities. Skilled nursing facilities in particular continue to struggle with labor shortages and increased patient acuity — both longstanding trends that were only exacerbated by the pandemic.
How can leaders of post-acute care facilities hope to adapt to these unprecedented challenges, while also preparing their organizations for future success? What tools can be leveraged to help ensure that the facilities under their charge are positioned to not just endure the current crisis but to come out on the other side with improved long-term viability?
To answer these questions, let’s begin by identifying the biggest challenges currently facing post-acute care providers.
3 Key Challenges Facing Post-Acute Care Providers
Challenge #1: Higher-acuity patients and residents
It should come as no surprise that patient acuity in nursing homes skyrocketed during Covid-19. But it’s also important to remember that it was just a larger spike amid an ongoing trend.
Indeed, patient acuity rates have risen steadily in skilled nursing facilities for decades. Back in 2008, Randy Lindner, executive director of the National Association of Boards of Examiners of Long Term Care Administrators (NAB), noted that “the acuity level of residents is much higher than it was 20 years ago.”
During the pandemic, this shift was even more pronounced. Research by PointRight showed that key indicators like depression and the use of restorative nursing more than doubled from 4Q 2019 to 4Q 2020. And some other conditions like cognitive impairment and swallowing disorders almost quadrupled during that same period.
Before the pandemic, the transition from hospital to nursing home was already trending earlier, thanks to changes in reimbursement policies meant to promote value-based care. And many skilled nursing facilities had actively embraced the idea of seizing these reimbursement dollars by accepting higher-acuity patients, even if that required additional workforce or infrastructure investments.
This may have been a viable strategy for future growth in a competitive market. However, it also helped set new industry expectations that have made it more likely for higher-acuity patients to be referred to SNFs in general. And that has only exacerbated the challenge for facilities that haven’t actively pursued this role, leading to a more pressing need for workers skilled in treating high-acuity patients.
Challenge #2: Staffing shortages
The shortage of clinical workers caused by Covid-19 is still a major challenge throughout the skilled nursing industry. According to a 2022 survey by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), 87% of nursing home providers currently face “moderate to high staffing shortages,” and a whopping 98% are “experiencing difficulty hiring staff.”
Staffing shortages don’t just threaten patient outcomes and an organization’s ability to grow. For many facilities, they also represent existential crises. The AHCA/NCAL survey found that three in five nursing home providers “are limiting new admissions” specifically because of these staffing shortages. And almost three in four worry about the possibility of “having to close their facilities over staffing woes.”
The shortage is driving up the cost of labor in a variety of other interrelated ways. The survey found that nine out of 10 nursing home providers “have offered increased wages and bonuses” to help acquire or retain the talent they need. And high turnover also comes with high administrative costs. Filing, credentialing work authorizations — organizing and managing it all takes time and labor.
Challenge #3: Worker burnout
Because so many nurses, aides and clinicians have opted out of the industry altogether during Covid-19, the ones who have stayed onboard are often called upon to work harder and more frequently. The AHCA/NCAL survey found that to “adjust for staffing shortages, nearly all (99 percent) of nursing home providers are asking staff to work overtime or extra shifts.” Nurse burnout has surged as a result.
“As many as half of the nursing workforce are experiencing burnout, with likelihood of personal consequence, job dysfunction, and potential risk to patients,” as the authors of a 2021 JAMA Network Open analysis pointed out. Along with emotional strain and the stress of Covid-19, the authors pointed to understaffing as a direct cause of the increase.
And that burnout has real, measurable effects. According to a study published in the Journal of the American Geriatrics Society, “RNs with burnout were five times more likely to leave necessary care undone,” and those who were “dissatisfied were 2.6 times more likely to leave necessary care undone.” This necessary care includes vital tasks like care planning and providing patient surveillance.
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“Being the only nurse on the unit too often forced me to confine my duties to immediate priorities, such as dispensing medications and dressing pressure ulcers,” as Alison Kris, PhD, RN, described her experience at a San Francisco-based nursing home to Wolters Kluwer. “There was rarely time to thoroughly assess or treat the patient’s symptoms and, consequently, many suffered needlessly.”
Kris’ experience was pre-pandemic, pointing to the status of staffing as a longstanding challenge in skilled nursing facilities. Yet in the face of a challenge that’s been so serious for so long, what hope to leaders have in 2022 and 2023, when nurse shortages are more pronounced than they’ve ever been before?
How Can Post-Acute Care Providers Overcome These Challenges?
Even in the face of all of these challenges, there’s reason to be optimistic about the future of post-acute care. Organizations like the AHCA/NCAL and the American Medical Association (AMA) are actively working to promote legislation to expand the pool of labor available to nursing homes and other facilities, which has gained bipartisan support among lawmakers.
Healthcare leaders looking to take more immediate action to secure the future of their organizations have a few options, too. For instance, partnering with a nationwide healthcare staffing and recruitment company can ensure access to a much wider bench of talent than may be available locally, including contingency workers like travel nurses from across the United States.
In addition, a wide variety of other workforce solutions exist that can cut costs by leveraging advanced technology. For instance, certain administrative tasks can be automated with the help of a healthcare managed services provider (MSP). By streamlining tasks related to hiring, billing and scheduling, healthcare organizations can accomplish much more with far fewer workers.
Prepare for the Future of Post-Acute Care with CareerStaff
Interested in learning more about how healthcare MSP and staffing services can help your organization prepare for the future of post-acute care? As a leading provider of healthcare workforce solutions, you can trust CareerStaff to guide you to the solution that best meets your specific and unique needs. Contact us here to connect with a CareerStaff professional.