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Hospitals and Nursing Homes (adopting CMS's standard-include Skilled Nursing Facilities (SNF) and Rehab Services in this article) must deliver care in a lockstep manner to achieve optimal patient outcomes, much like the two hands that come together precisely at the timed and coordinated moment to produce the sound of a simple clap. If you are a healthcare provider, ACO (Accountable Care Organization) or a health plan, the two most crucial factors to evaluate in a nursing home partnership are- the capacity, which simply means- do they consistently and timely make a bed available to the patients that need it, and have quality of care which means- that you are discharging your patient into safe hands (and also that they recover as intended to go home and not return to ERs and require re-hospitalizations). Both of these factors have a bearing on the total cost of care which might be important for you to manage. We will focus on the Nursing Home (NH) capacity in this article. Once a decision is made by the physician to discharge the patient to go to a nursing home, the time it takes to move the patient out of the hospital bed and turn it around for the next patient impacts two key inpatient hospital metrics that most hospitals and (or) insurers care about-The Average Length of Stay (ALOS) and The Average Hospital Bed Turnaround Time (can impact your ED wait times potentially). Both of these metrics are indicators of efficiency of your operations and potentially impact hospital revenues as well as expenses (cost) besides having an undeniable impact on your provider (staff) engagement and patient satisfaction metrics.
Overview of the Bed Capacity of Medicare-certified Nursing Homes in the United States
Table 1: Medicare-certified Bed Capacity in the United States
There is almost an even split (50:48 %) in the number of nursing homes categorized by their size (# of beds) between the small (1-99 beds) and medium (100-299 beds), perhaps confined to rural (small) and urban (medium) areas (needs confirmed). The large (300-499) and super (500 & over) sized facilities are negligible fractions in comparison. Average available bed capacity across the country is around 30% which means that approx over 70% of the nursing home beds on the average in the country are occupied (avg occupancy rate) by residents at any given time. In comparison, the average bed occupancy rate at acute care hospitals in the US ranges between 55-64% and more expensive to maintain
Majority of the >15K nursing homes in the US are certified by Medicare. While Medicare patients typically use them for shorter stays immediately following discharge from an acute care facility and needing specialized care, Medicaid patients are the largest consumers and tend to have longer stays (Medicaid covers over 60% of all nursing home patients)
State-by-State Overview of NH Bed Capacity in the United States
State-by-State Overview of NH Bed Capacity in the United States
Seven States with 20% or lower average available bed capacity in NHs
Seven States with 20% or lower average available bed capacity in NHs
This could potentially impact the discharge process for patients going to NHs by increasing the ALOS (if actual time is considered when the patient left the bed vs when the discharge order is written) and the hospital throughput. Do you know your hospital or health systems ALOS for patients discharge disposition of NH and the bed turnaround times?
Eleven states on the "cusp" with 21-25% available bed capacity have significantly higher number of counties with low bed capacity
Regions (counties) within the states still experience delays in patient transfers to nursing homes
Nineteen states generally have adequate bed capacity available
There can still be fewer pockets (regions) with bed capacity issues, causing delays in transfers or in receiving patients discharged from the acute care hospitals
We will review the available capacity within the counties in the states to highlight the regional and local situational awareness and potential challenges in nursing home bed availability across the country
References:
Jones RP. Would the United States Have Had Too Few Beds for Universal Emergency Care in the Event of a More Widespread Covid-19 Epidemic? Int J Environ Res Public Health. 2020 Jul 19;17(14):5210. doi: 10.3390/ijerph17145210. PMID: 32707674; PMCID: PMC7399859
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