A trend has been developing over the past decade or so involving hospitals discharging seniors sooner to skilled nursing centers, and an increase in high acuity or medically complex residents. Populations in skilled care have changed greatly, and it seems like this will continue for some time in the future. The level of acuity in skilled nursing centers has never been greater and some care centers have become miniature hospitals or sub-acute care facilities. Some experts say that assisted living, for instance, is now becoming what nursing centers used to be like 20 years ago.
A Snapshot of the Situation
Currently, there are 125 million Americans suffering from chronic medical conditions. This burden is magnified when you take into account that chronic health conditions often occur as comorbidities rather than single, isolated problems. Of these 125 million people, 60 million have multiple chronic health conditions which are associated with increased levels of disability and decreased quality of life. The occurrence of comorbidity is age-dependent, with almost 70% of people over age 65 having two or more chronic conditions.
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Acute care hospitals are discharging seniors sooner, and those who cannot go home are admitted to skilled nursing centers for post-acute care and treatment. Most skilled care centers are now serving two distinct resident populations – those who are there to receive rehabilitation after a knee or hip replacement, and those who require skilled care for the rest of their lives. With this increase in acuity, there will be both rewards and risks in delivering care to medically complex residents.
Examples
What kinds of care are provided when skilled nursing centers deliver treatment to residents with high-acuity, medically complex conditions? Some residents may require long-term ventilation care. Some will need cardiac or pulmonary treatment. Others will require hemodialysis. Still, other residents who are older may have complicated neurodegenerative disorders and require a completely different level of care and for a long period of time. Conditions including Alzheimer’s, Parkinson’s, Huntington’s, Multiple Sclerosis, Amyotrophic Lateral Sclerosis (ALS) and HIV will require special skills from nursing staff and others.
Still, other residents may need complicated wound treatments and some may be admitted from the hospital with a tracheostomy. These types and levels of care are not inexpensive. In addition to cost, nursing staff will either already be prepared to deliver high acuity care or will need to be intensively trained on such conditions and treatments. Learning how to use new medical equipment will also need to be addressed.
In addition, there will be multiple administration and operational challenges involved in delivering medically complex care to a fragile resident population. Issues such as reimbursement, the increased use of antibiotics, specialized equipment and the use of new technology, and ongoing staff training will take center stage in skilled nursing facilities who decide to offer high acuity care.
Final Thoughts on Caring for High Acuity Residents in Skilled Nursing
Times are changing in skilled nursing centers across the United States. These are not our grandmother’s nursing homes by far. As hospitals discharge older adults with chronic health conditions, skilled nursing centers are fulfilling a need to admit and provide care to individuals with medically complicated health conditions. This is no easy task. Many skilled facilities are now resembling mini hospitals and sub-acute care centers. A great deal of resources will need to be pumped into training and education, specialized equipment, staffing, medication and leadership. The trend is going strong right now, and if it continues, skilled nursing might just become a new type of hospital for seriously ill, older adults. Only time will tell.
(NOTE: Interested in CEUs for Nursing Home Administrators? Checkout my Nursing Home Administrator CEUs on CEU Academy and try a FREE CEU today!)
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