Tom Martin

How the pandemic fueled a shift to home-based healthcare

March 29, 2021
By Tom Martin

When the Covid-19 pandemic struck in early 2020, it quickly — and dramatically — evolved the ways in which people received care. As Covid-19 case counts proliferated, many patients and providers opted for home-based care to limit the risk of exposure to the virus. This consequently impacted care transitions, referral patterns and care delivery across acute and post-acute settings, accelerating a new paradigm in care management that is poised to extend post-pandemic.

Namely, home-based care has been solidified as a new norm — but how precisely did that happen? And what are the implications for post-acute care delivery once the pandemic is over? To understand the rise of home-based care, it’s important to first understand the circumstances that led to it.

Hospital inpatient volumes dropped
In March 2020, CarePort Health found that inpatient volumes across its hospital customers dropped by a staggering 30%. This dive has been seen across U.S. geographies, even though the pandemic impacted different regions with varying severity at different periods of time.

It wasn’t until May 2020, when elective surgeries resumed, that inpatient volumes across hospitals began to return to pre-pandemic levels.

Post-acute care referrals plummeted
Post-acute providers witnessed a similar trend in terms of referral volumes. With many facilities in lockdown, patients’ families worried they would be unable to visit loved ones during skilled nursing facility (SNF) stays. People were also more likely to be either working from home or unemployed, and were able to assume caregiving responsibilities once reserved for SNFs. As a result, CarePort data shows that SNF referrals dropped 34 points during March and April of 2020. Likewise, patient referrals to home health dropped 32 percentage points during the same time period.

SNFs continue to struggle today, while home health care thrives
While historically there has been an even split in referrals between SNFs and home health, the pandemic has shifted this ratio, and home health now comprises 55% of referrals to post-acute care, according to CarePort data. By July 2020, referral volumes to home health agencies had restored to normal levels, and home health agencies within CarePort’s network saw referral trends reach 109% of 2019 totals by October 2020.

CarePort data also shows that SNF occupancy rates are at an all-time low – 71% nationwide as of January 2021 – despite facilities having the resources available to safely accommodate patients. In fact, as of January 2021, 73% of SNFs reported accepting Covid-19 patients during the pandemic, 99% reported sufficient testing capabilities for staff and residents, and 92% have the necessary personal protective equipment (PPE) required to maintain patient and staff safety. Demand remains negligible, however; whereas in January 2020, 32% of the nation’s SNF providers reported having occupancy rates greater than 90%, only 9% of providers have reached that level of occupancy during the same time this year.

There has been a slow but steady trend of facilities closing over the past five years, but the past year of Covid-19 has culminated in a disproportionate number of closures — 114, in fact, according to national data. As the pandemic continues and provider relief funds dwindle, more closures are expected to continue.

As we move toward a home-based care model, care coordination tools are increasingly critical
Because patient discharges continue to trend toward home health rather than SNFs, SNF referral volumes are expected to lag for the foreseeable future – potentially for the long term.

Due to the marked shift to home-based care over the past year, solutions that facilitate enhanced communication and transparency between acute and post-acute providers are vital to successful care coordination initiatives and positive patient outcomes. Whether used to develop a coordinated treatment plan, offer increased visibility into home health care, or schedule follow-up telehealth or in-person appointments, care coordination tools help ensure providers can track and manage patients across the continuum, and support appropriate patient care – regardless of where or how that care is being delivered.

Data reported here is based off of CarePort customer hospitals and may not be representative of the nation at large.

About the author: Tom Martin is the director of post-acute care analytics at CarePort, powered by WellSky. He has led several data analytics teams providing insight to healthcare providers trying to improve quality of care for their post-acute care patients. He holds an M.S. in Resources Economics with a concentration in econometrics from the University of Massachusetts Amherst. As director of post-acute care analytics at CarePort, Tom studies how the ever-changing PAC regulatory and payment landscape is impacting care delivery and how acute and post-acute providers can leverage their data to improve patient care.