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Covid has led to a major shift away from short-stay, post-hospital care at nursing homes & towards home-based care. Key question is when & if (!) these lucrative Medicare nursing home patients are coming back. Short
based on this @WSJ piece. https://www.wsj.com/articles/covid-spurs-families-to-shun-nursing-homes-a-shift-that-appears-long-lasting-11608565170
based on this @WSJ piece. https://www.wsj.com/articles/covid-spurs-families-to-shun-nursing-homes-a-shift-that-appears-long-lasting-11608565170
Quick background: Nursing homes broadly care for two groups of individuals: short-stay Medicare patients associated with double-digit margins & long-stay Medicaid residents associated with negative margins in most states. Medicare drives the economics of nursing homes. 2/
Most individuals leaving the hospital prefer post-acute care in the community. There is uncertainty about who can be cared for safely & effectively in community, but evidence from ACOs & bundled payment does suggest some ability to sub towards home. 3/ https://www.nejm.org/doi/10.1056/NEJMp1901896?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Decline in Medicare short-stay nursing home care started pre-pandemic but has accelerated during the pandemic. As of May 2020, skilled Medicare nursing home services were down 44% since Jan 2018. 4/
According to @careporthealth EHR data through Oct 2020, hospital discharges shifted to home health and away from nursing homes (a.k.a. skilled nursing facilities) as hospital volume recovered from the initial months of the pandemic. 5/
Not surprisingly, there has been a shift in employment across these settings. Based on @BLS_gov data, employment at nursing homes is still declining as of Nov 2020 while home health employment is rebounding. 6/
Key question is whether short-stay Medicare discharges will return to nursing homes in the near future. From patient perspective, it is good if more care can be done safely/effectively at home. However, huge implications for nursing home & home health sectors going forward. END/
