The state Department of Health is aware of the ongoing issues of hospitals and skilled nursing facilities (SNF) facing challenges in moving a hospital patient to a nursing facility and nursing facilities not accepting patients because they don’t have adequate staffing.

DOH Spokesman Mark O’Neil said the administration took critical steps to support health systems during those staffing shortages last year.

“You may recall that the department put several strike teams in place across the state to help reduce the strain on hospitals and create additional capacity for patients to be moved from hospitals to SNFs with adequate staffing,” said O’Neil. “The administration also worked swiftly with the Legislature in a bipartisan manner to appropriate $225 million to support the health care workforce.”

The administration also prioritized addressing funding for these facilities in the governor’s budget proposal and the final state budget invests more than $500 million, with the expectation that the hundreds of millions of dollars would support quality care for Pennsylvania’s nursing home residents, he said.

“The increased payments, which go to direct resident care, and the federal funding, which can be utilized for, among other things, staff recruitment and retention, are necessary to maintain and increase quality of care for the residents,” said O’Neil. “In addition, the budget included funding accountability language requiring nursing facilities to spend a minimum of 70% of their funding on resident and resident-related costs. This accountability language is expected to go into effect in 2023.”

While the state does not have vaccination requirements for skilled nursing facilities, it strongly encourages vaccinations in these settings. Some SNF workers, however, are subject to a vaccine requirement from the federal Centers for Medicare and Medicaid Services (CMS), he said.

The state does not track data on how many patients are affected by this, said O’Neil.

“The department does not track this information, as tracking such situations in rapidly-changing health care settings would be counterproductive and potentially interfere with patient care,” he said. “Hospitals and long-term care facilities often resolve transfer issues quickly on their own. As noted above, during the peak of COVID-19 when hospitals and nursing homes were both overwhelmed, the department initiated multiple short-term remedies to help mitigate the situation.”

Contributing factors

Garry Pezzano, President and CEO of LeadingAge PA, an association representing more than 360 aging services providers across the state, said the relationship between hospitals and long-term care providers plays an essential role within the aging services ecosystem, as skilled nursing communities often operate short-term rehabilitation units where older adults receive specialized care after a hospital stay.

“Many long-term care providers throughout Pennsylvania, including members of LeadingAge PA, have been forced to make the difficult decision to limit admissions of new residents repeatedly over the past several years, often into those on-site rehabilitation units,” said Pezzano. “Our members have strong relationships with their local hospitals and health systems and communicate frequently about discharges and bed capacity and make these capacity decisions on a weekly or daily basis based on staffing levels and COVID-related isolation requirements.”

Pezzano said there are two primary factors and one secondary factor that contribute to the decision to limit admissions: “the current workforce crisis, outdated COVID-19 protocols, and inadequate funding. LeadingAge PA members are mission-driven organizations that want to provide needed care and services to as many older adults as possible, however, they are not going to admit new residents when there is a risk of providing a lower level of care due to lack of staff, and not enough single rooms to adhere to COVID-19 isolation protocols.”

Pezzano said nursing homes struggled to keep dedicated workers, in part because Medicaid funding remained flat for years, making it impossible to keep up with even basic inflationary costs.

“The pandemic only made this worse, further exacerbating the funding and workforce crisis as nursing homes struggle to ensure access to care for some of Pennsylvania’s most vulnerable residents,” he said. “According to a report commissioned by LeadingAge PA, nursing homes were underfunded by nearly $1.2 billion in Medicaid in 2019-2020, nearly double the shortfall from just a few years prior.”

‘Much-needed’ funding

The recently enacted 2022-23 state budget provided the first across-the-board Medicaid funding increase for long-term care in nearly a decade, Andreano said.

“This funding, which will begin to be distributed in January 2023, is a much-needed first step, however, the record inflationary costs and COVID-19-related expenses continue to drain an already struggling sector,” said Pezzano. “Plus, the Pennsylvania Supreme Court’s recent decision to reverse the venue shopping rule, which also goes into effect in January, will only perpetuate the financial instability of aging services providers and further jeopardize access to long-term care.”

There are no quick solutions here, but there are some places to start, he said.

“Providers can’t wait every 10 years for a funding increase, while access to care hangs in the balance,” said Pezzano. “Now that the COVID-19 virus is becoming a part of everyday life and the threat of severe outcomes has lessened, it’s time to rethink and reverse the rules and regulations that are no longer necessary and inhibit both providers’ ability to operate efficiently and residents’ quality of life.”

Significant investment needs to be made in the aging services workforce, he said.

“Resolving testing capacity issues, which are preventing Temporary Nurse Aides from getting certified is one place to start,” said Pezzano. “Increasing investment in training programs and educational opportunities that would create career ladders (for example, Medication Administration Training) and build a pipeline of future caregivers, coupled with funding increases to support competitive wages and benefits would also begin to address this issue.”

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