scholarly journals Strategies to Maintain Skilled Nursing Facility Staffing during COVID: Administrator Perspectives

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1055-1056
Author(s):  
Amy Meehan ◽  
Renee Shield ◽  
Caroline Madrigal ◽  
Joan Brazier ◽  
Emily Gadbois
Keyword(s):  
Financial Incentives ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Direct Patient Care ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Staffing Levels ◽  
Flexible Schedules ◽  
The Impact ◽  
Adequate Staffing

Abstract As COVID-19 has resulted in a skilled nursing facility (SNF) staffing crisis, administrators attempt to maintain adequate staffing and stem decreasing patient census levels. We conducted four repeated interviews to date (n=130) at 3-month intervals with administrators from 40 SNFs in eight diverse healthcare markets across the United States. We used thematic analysis to examine their perspectives over time, including the perceived impact on staffing. Results include: 1) the impact of COVID-19 on staffing levels, and 2) strategies used in response to this crisis. Staffing levels have decreased throughout the pandemic, and struggles to maintain adequate staffing levels and patient census numbers have continued as the pipeline of potential new staff constricts. Facilities turned to agencies, many for the first time. Since agencies offer higher salaries, staff are drawn away from employment by SNFs, leading to a cycle of wage wars, and agencies are also challenged to provide staff. SNF administrators describe their responses to this crisis, such as flexible schedules, increased paid time off, sharing of non-direct-patient-care tasks, financial incentives (referral, sign-on, “no-call out”, and other general bonuses); wage analyses, and enhanced employee benefit packages. Some hire recruitment specialists, collaborate with nearby administrators, use creative advertising, or work with local schools. The vaccine mandate worries administrators; as one stated: “I can't afford to lose one person, let alone 20 because of this mandate...”. Given the dwindling pool of potential employees, we present NH administrators’ strategies to attract and retain staff.

The effects of telehealth use for post-acute rehabilitation patient outcomes

2016 ◽  
Vol 24 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Stephanie A Hicks ◽  
Verena R Cimarolli
Keyword(s):  
Cognitive Functioning ◽  
Patient Outcomes ◽  
Skilled Nursing Facility ◽  
Functional Independence ◽  
Emergency Department Visits ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Care ◽  
Acute Rehabilitation ◽  
The Impact

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

The Impact of a Skilled Nursing Facility on the Cost of Surgical Treatment of Major Head and Neck Tumors

2001 ◽  
Vol 127 (9) ◽  
pp. 1086 ◽  
Author(s):  
Hadi Seikaly ◽  
Karen H. Calhoun ◽  
Jana S. Stonestreet ◽  
Christopher H. Rassekh ◽  
Brian P. Driscoll ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Skilled Nursing Facility ◽  
Head And Neck Tumors ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Neck Tumors ◽  
The Cost ◽  
The Impact

Hospitalization and hospital discharge destinations after chemotherapy: Using the Oncology Care Model (OCM) methodology in 2012–2015 Medicare data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 113-113
Author(s):  
Yi Peng ◽  
Jiannong Liu ◽  
Leon Raskin ◽  
Michael Anthony Kelsh ◽  
Rebecca Zaha ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Incentives ◽  
Quality Care ◽  
Skilled Nursing Facility ◽  
Cancer Type ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Practice Performance

113 Background: The Medicare OCM gives financial incentives for efficient, high-quality care. Hospitalizations of cancer patients receiving chemotherapy substantially increases costs. We assessed reasons for hospitalization and hospitalization discharge destinations after chemotherapy in cancer patients. Methods: We applied OCM methodology in a Medicare fee-for-service 20% sample data to estimate 6-month patient episodes triggered by chemotherapy from 2012 to 2015. We summarized the most frequent reasons for hospitalization (using ICD-9-CM codes in the first 5 positions of hospital claims) and the discharge destinations among all episodes and by cancer type. Results: Of 485,186 6-month episodes in 255,229 patients, 121,886 (25%) episodes had ≥1 hospitalization. The most frequent reasons for hospitalization were infection (13%), anemia (7%), dehydration (5%), and congestive heart failure (CHF; 3%; Table). Most hospitalized patients were discharged to home (71%) or a skilled nursing facility (SNF; 13%); some died in the hospital (6%) or went to hospice (5%). Reasons for hospitalization and discharge destination varied by cancer type. Patients with lung cancer had the highest rates of infection and anemia and higher proportions of death and hospice discharge compared with other cancers. Conclusions: Among Medicare beneficiaries receiving chemotherapy, hospitalizations most often occurred as a result of infection or anemia. Patients were most often discharged to home or SNF. Variations across cancer types in the reasons for hospitalization, as well as discharge destinations, should be considered when evaluating OCM practice performance. [Table: see text]

scholarly journals Improving Healthcare Value: COVID-19 Emergency Regulatory Relief and Implications for Post-Acute Skilled Nursing Facility Care

2020 ◽  
Vol 15 (8) ◽  
pp. 495-497
Author(s):  
Ann M Sheehy ◽  
Charles FS Locke ◽  
Farah A Kaiksow ◽  
W Ryan Powell ◽  
Andrea Gilmore Bykovskyi ◽  
...  
Keyword(s):  
Care Delivery ◽  
Skilled Nursing Facility ◽  
Marked Change ◽  
Hospital Medicine ◽  
The United States ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Social Security Act ◽  
The 1960S

Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

scholarly journals POLICY AND QUALITY: THE IMPACT ACT OF 2014 AND DEVELOPMENT OF THE SKILLED NURSING FACILITY QUALITY REPORTING PROGRAM

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 26-27
Author(s):  
A Ptaszek ◽  
A Deutsch ◽  
Q Li ◽  
A Cool ◽  
L Smith ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Quality Reporting ◽  
The Impact

Professional characteristics of deficiency citations at F-248 in skilled nursing facilities in the United States

2012 ◽  
Vol 11 (2) ◽  
pp. 32-38
Author(s):  
Timothy J. Legg, PhD, RN-BC, CNHA, GNP-BC, CTRS, FACHCA ◽  
Sharon A. Nazarchuk, PhD, MA, MHA, RN
Keyword(s):  
Skilled Nursing Facility ◽  
The United States ◽  
Therapeutic Recreation ◽  
Professional Activity ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Survey Participant ◽  
Professional Characteristics ◽  
Participant Response

In an earlier study, the authors attempted to determine which professional activity group (the certified therapeutic recreation therapist vs certified activity director) received fewer survey deficiencies in the skilled nursing facility. The original study was unable to provide an answer to this question due to low-survey participant response rate. The study was further limited in terms of geographic scope, as it was confined to a single state. The current study replicates that earlier study with an increased sample size and nationwide geographic distribution of participants.

scholarly journals 432. An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility – California, 2021: Description, Mitigation, Challenges, and Opportunities

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S318-S319
Author(s):  
Anastasia Maletz ◽  
Grace Kang ◽  
Raymond Y Chinn ◽  
John D Malone ◽  
Hosniyeh Bagheri ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Skilled Nursing Facility ◽  
Geographic Location ◽  
The United States ◽  
Infection Prevention And Control ◽  
Whole Genome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk

Abstract Background Skilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States; however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. Methods We report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Figure 1. Epi Curve of COVID-19 Outbreak in a Skilled Nursing Facility Figure 2. Timeline of COVID-19 Outbreak in a Skilled Nursing Facility Results Factors that contributed to the outbreak: delay in test results had an impact on cohorting; suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring; strict criteria were used to screen for infection; the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons; symptomatic HCWs who continued to work; the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment; poor indoor air quality due to ventilation challenges; and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents’ CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Whole Genome Sequencing of Isolates from a Skilled Nursing Facility Outbreak Univariate Analysis of Selected Variables Associated with Mortality among Residents at Facility A during COVID-19 Outbreak, June 19 - July 21, 2021 Multivariate Analysis of Factors Associated with Mortality from COVID-19 after Adjusting for Age among Residents (N =124) of Facility A, June 15 - July 21, 2020 Conclusion While implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs. Disclosures All Authors: No reported disclosures

Abstract P387: Length of Stay Among Medicare Beneficiaries Hospitalized with Heart Failure

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Emily B Levitan ◽  
Melissa K Van Dyke ◽  
Ligong Chen ◽  
Meredith L Kilgore ◽  
Todd M Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Systolic Dysfunction ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Demographic Characteristics ◽  
Hospital Length Of Stay ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Heart failure (HF) is among the most common reasons for hospitalization in the United States. Hospital length of stay (LOS) is a driver of cost and disease burden. Objectives: To examine factors associated with LOS of HF hospitalizations. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims with ≥1 overnight stay/2 hospital days with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. The median and interquartile range (IQR) LOS was calculated by demographic characteristics, comorbidities, and discharge status based on Medicare claims data with the Kruskal-Wallis test to compare distributions in the overall population with HF (n = 45,584) and in the subpopulation with documented systolic dysfunction (n = 10,256). Results: The median LOS was 5 days (range 2-255, IQR 4-8 days) in the overall HF population and 5 days (range 2-204, IQR 4-8 days) in those with systolic dysfunction. Across most demographic characteristics and comorbidities, the median LOS was 5 days but was higher among nursing home residents and individuals with malnutrition in both groups and with chronic kidney disease in those with systolic dysfunction ( Figure ). All comorbidities were associated with a shift in the distribution toward longer LOS in the population with systolic dysfunction and all but coronary heart disease in the overall population (p < 0.001). HF patients discharged to a skilled nursing facility had longer LOS (median 7 days, IQR 5-10 days) versus other discharge statuses (median 5 days, IQR 3-7 days, p < 0.001) in both populations. Conclusions: In patients hospitalized for HF, the median LOS was 5 days across most comorbidities and other characteristics, but comorbidities were associated with a shift in the upper tail of the distribution toward longer LOS. Worse functional status (nursing residence or discharge to a skilled nursing facility) was associated with a higher median LOS.

Abstract 15301: Skilled Nursing Facilities and 30-day Hospital Readmissions in Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
Revolving Door ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Classification Of Diseases ◽  
The Impact

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.

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