The novel coronavirus pandemic has brought a series of unique challenges to the post-acute care sector. Flaws and gaps in our healthcare system, especially for seniors in skilled nursing facilities (SNFs), continue to be exposed even as we begin to administer the COVID-19 vaccines.
One of the many lessons learned from COVID-19 is that we cannot return to the way things used to be. Occupancy rates in SNFs are down across the nation and those who are living in these facilities have faced uncertainty and unfathomable levels of loneliness and isolation. But from tragedy comes opportunity, we must advance efforts to respect and protect the vulnerable people who consider SNFs home. SNFs must begin to re-define their place in the care continuum, caring for our seniors today while preparing for the baby boomer generation of tomorrow.
How SNFs can prepare for the future
It’s important to understand that all SNFs are not the same. Many, especially older facilities, require waivers because their tight hallways and tiny rooms do not meet regulation square footage. Even some of the newer facilities were intentionally designed with cozy common spaces and multiple communal areas in an effort to feel less ‘institutional’ and more homelike. These physical plant challenges made implementing COVID-19 precautions nearly impossible. The only option left for many SNFs was to confine residents to their rooms, leaving seniors feeling lonely for the past year.
While occupancy is down, is this the right time to consider decertifying Medicare beds permanently and moving from double to single occupancy? Would having more spacious, technologically enhanced “smart” rooms attract a more discerning private pay resident at a higher daily rate? More square footage would also allow seniors to bring in more personal items from home, creating their own oasis with enough room for a sitting area for socialization and meals with loved ones. In addition – high-speed Wi-Fi enabled rooms would allow for residents to easily initiate virtual online meetings with family and friends and allow for more universal telehealth access at the bedside.
While this may be a substantial investment, it will better prepare SNFs for 60- and 70-year-olds who may begin to require short stays and possibly even longer stays sooner rather than later. The pandemic has also led to more technology spending by senior living providers than ever before. A survey conducted by Senior Housing News found that 80% of respondents reported an increase in tech spending this year to help address the pandemic, and another 87% believe that their organization will increase their technology budgets in 2021. Technology is very quickly becoming an expectation, not a luxury, and SNFs need to factor this into their immediate futures.
While technology can never replace face-to-face patient engagement, it does provide an opportunity for loved ones to connect during these extremely challenging and complex circumstances. That said, being mindful of some seniors’ limited proficiency or interest in learning to use a smart TV, tablet or other device is extremely important. Including telehealth as a long-term solution for SNFs will face some practicality challenges – including having someone at the SNF assisting with the technology. Feeling frustrated by unfamiliar technology intended to help is likely to exacerbate feelings of insecurity and discontent.
Even mentioning the idea of decertification of beds in the SNF industry is considered blasphemy. From a business perspective, each bed is a revenue source – if not real today – then at least potentially tomorrow. But at what cost are we willing to see those beds go unfilled with occupancy stalling due to the pandemic? In states like Texas, a non-certificate of need state – any rebound is going to be slower and less likely. It would be unwise to continue to create and attempt to balance a budget where food, utility and staffing ratios are difficult to shift based on a failing census.
The shocking COVID-19 mortality rate among those living in SNFs is difficult to fathom. Equally insidious is the living grief of residents and families who have been kept apart in the name of safety. The ongoing anxiety, confusion and associated detriment to overall health suffered by seniors cannot be underestimated. We are still far from knowing the full nature or extent of COVID-19’s impact. One thing, however, does seem clear: the time is now to plan for the future of SNFs.