Earlier than the COVID-19 pandemic, it was not unusual for house well being companies and different post-acute care suppliers to beg hospitals to turn out to be a part of their post-acute networks.

Three years later that’s often not the case. Referral patterns in house care have undergone a radical change, and company leaders are nonetheless adapting to those modifications and making changes alongside the way in which.

“We had been used to listening to from hospitals that we needed to have a five-star ranking, a medical director and all these different help providers,” mentioned Erin Shvetzoff Hennessey, CEO of Well being Dimensions Group (HDG) on the Continuum convention Ageing Media Community in December. “Now hospitals are realizing that the sufferers they want help with discharge don’t all the time match into this five-star mannequin. These are tough sufferers and typically tough sufferers lead to analysis actions that don’t put you within the five-star class. So while you begin creating this community of most popular suppliers, it turns into slightly an excessive amount of preferential – they usually want post-acute care to take these sufferers and clear the hospital.”

HDG operates a portfolio of 25 senior dwelling communities throughout eight states. It additionally possesses a number of expert nursing qualities.

Hennessey mentioned that as a result of sufferers being discharged from the hospital are extra sophisticated than earlier than, two completely different referral teams are beginning to emerge.

On the one hand, there are the five-star referral companions that meet all of the sure standards that hospitals like.

“After which there's this off-to-the-side community that we all know discharge planners are actually connecting to post-acute,” Hennessey mentioned. “These are the suppliers who say sure. Now now we have this formal community and this casual community that truly will get sufferers transferring.”

The variety of referrals to house care has elevated steadily over the previous three years. On the similar time, suppliers are rejecting them at an unprecedented price.

As hospitals try to position sufferers within the arms of applicable post-acute suppliers, expert nursing facility referral volumes have recovered.

For a healthcare system like Ascension, asset possession is a vital piece of the puzzle for the corporate's success. Nevertheless, it doesn’t have enough property.

“I don't know that any system can have all of the sources they should take care of the continuum,” mentioned Lisa Musgrave, SVP of post-acute and residential care at Ascension. “For us, constructing a referral community was crucial.”

Ascension is a faith-based well being care system that additionally gives house well being and post-acute care.

To maintain up with the rising variety of referrals, and as hospitals more and more depend on post-acute suppliers, discovering the correct referral companions has been crucial post-pandemic.

Musgrave has found that sharpness is king above all.

“We’re searching for individuals who wish to associate with us in taking increased acuity sufferers,” Musgrave mentioned. “It's all about sharpness now. It's about behavioral well being points and who's going to work with us to take these hard-to-place sufferers and who's going to speak with us throughout the continuum. We’re searching for companions who merely wish to work with us to maneuver sufferers.”

There’s additionally a fragile stability that house care companies should contemplate. Too broad a referral web could be detrimental to companies that target high quality and outcomes.

However, a referral community that’s too small can result in stagnation.

“We are saying our referral networks are simply slender sufficient,” Musgrave mentioned. 'And doubtless simply deep sufficient. We don't wish to have too many individuals in our community as a result of we all know that if we ship all our sufferers with issues to the people who find themselves nice companions and we ship all the great sufferers to another person, it received't work. We actually do our greatest to restrict our networks to the most effective communicators, the most effective companions, the most effective gamers in our market and to make that ratio work financially for our supplier networks.”

One other vital shift that suppliers are grappling with is whether or not these sophisticated sufferers belong in a house care setting or a talented nursing surroundings.

Invoice Gammie, senior director of post-acute utilization at Kaiser Permanente, is in the course of that push and pull.

“We noticed SNF use hovering round 18% earlier than the pandemic,” Gammie mentioned. “In 2021 it dropped to round 15% – now we see it rising barely once more. That shift has pressured us to ask, “Who’re the correct members to maneuver into expert nursing and is there an overuse of expert nursing past instant medical want?”

Kaiser Permanente is among the largest well being care techniques and medical teams within the nation. The well being care plans cowl 13 million folks in eight states.

The house care community consists of roughly 26 companies, together with corporations comparable to LHC Group, Bayada House Well being Care and Pavilion Medical House Care & Staffing.

As a payer, Gammie mentioned it's tough to stability these two objectives directly: making certain sophisticated sufferers get the care they want, whereas additionally making certain they don't default on an SNF primarily based on their want .

“We all know there are further wants – largely within the space of ​​custodial care – and we all know there are limits to our profit designs,” Gammie mentioned. “We had to take a look at sample shifts and had been concerned in avoiding members of the family from going to SNFs due to all of the tales that had been taking place throughout the pandemic [at these facilities]. At the moment, households stepped up and met shelter wants.”

Now that issues have normalized, companies and payers are looking for a brand new, proper stability.

“We’ve got to be stewards of the profit,” Gammie mentioned. “We wish to see the correct referral patterns for expert nursing and residential care. However on the similar time, as we've seen this resurgence in the usage of expert nurses, the gaps in shelter wants and the way households could or could not have the sources to help their members to remain wholesome at house continues to be a problem the place we stand for. We’re engaged on an answer.”

Hennessey, a lifelong healthcare veteran, echoed that sentiment.

“Expert care is the place my coronary heart lies,” she says. “However folks shouldn't get expert care in the event that they don't want expert care. It’s not all the time a medical want that brings somebody to expert care; it’s typically a cycle of social wants blended with the medical wants. If we discuss that in between: that’s the home.”