Post-Acute Care Shortage: WellSky Report Looks at the Impact on Hospitals and Patients

By Matt Phillion

A new report by WellSky looks at why the healthcare industry continues to struggle to provide patients care outside the hospital even after the surge of COVID-19 patients has de-escalated.

The report finds that:

  • Hospitals are finding it harder to place patients in home care and nursing homes. Referrals to skilled nursing facilities (SNF) and home health agencies (HHA) have increased 10% and 11%, respectively. At the same time, rejection rates to HHAs have skyrocketed 40%.
  • The challenge of staffing shortages persists. 87% of nursing homes face moderate to high staffing shortages, with 54% of nursing homes turning away patients because they lack the staff to care for them, and 61% limiting new admissions.
  • The average length of stay in the hospital has increased for patients released to SNFs or HHAs, leading to longer wait times and decreased patient satisfaction.
  • Hospitals are seeing higher-acuity patients, which increases length of stay, strains staff, and puts pressure on the secondary facilities those patients transfer to.

“One of the things the report highlights is that while we’ve talked about staffing challenges and rejection rates, what’s interesting is that there’s a direct correlation between rising rejection rates and length of stay for patients being referred to skilled nursing facilities or home health,” says Lissy Hu, president of connected networks at WellSky. “When you look at patients who leave the hospital and go to skilled nursing facilities, their length of stay has increased by a day or more, and the same with home health.”

A single day added to an acute care stay is a big deal for a hospital. “We know post-acute care is very top of mind for hospitals. When they’re unable to turn over beds and get patients to post-acute care, discharge planners can’t move the patients out of the hospital. It is all interconnected and then impacts their bottom line,” says Hu.

The data takes a new look at a problem WellSky has had its eye on for a while. “One of the reasons the data in this report is so unique is we’re able to tie together patients across settings of care, rather than just looking at individual settings of care, like skilled nursing, at-home [care], or in hospitals,” she says. “We can tie these things together in a very clear way to explain what we mean when we say this is a care continuum. What happens on the post-acute side has a direct impact on hospital operations.”

It’s been said that health systems investing in value-based care are the ones striving to build post-acute care networks and work with providers in this space, says Hu—explaining that those systems have more financial incentives to manage the overall cost of care—but now, with increased lengths of stay, it’s more important than ever for fee-for-service organizations as well. “It’s relevant no matter what type of payment model you’re in,” she says.

The impact on patients

From a patient recovery and safety standpoint, it’s worth noting that the day-plus Hu cites as being added to patient stays is the mathematical average, with many patients staying five or 10 days longer in the hospital. “The average in some ways masks that they’re staying longer because the hospital can’t find the right post-acute placement for them,” Hu says. “Some are staying a week or two more, and additional days in the hospital are not necessarily the best thing for the patient. It delays their recovery, increases the risk of acquired infections, and so on.”

Length-of-stay challenges have an impact on individual patients, but also on the patient population overall in terms of care access. “Things like surgeries have to be pushed back; people in the ED who can’t get admitted linger there. It has an impact on many patients at the same time who can’t get a bed in the hospital,” says Hu. “You’ve got patients boarding in the ED who can’t be admitted until someone moves on from their inpatient floor.”

Meeting the silver tsunami head-on

The current challenges surfaced by the report feel like a harbinger of things to come, Hu says. “We’re in the early innings of the silver tsunami of aging baby boomers. They’re an increasingly frail and elderly population, and we’re also seeing an increased prevalence in chronic conditions,” she says. “We have more older patients, but also sicker patients and those with more diverse needs, which is driving up the need for space in post-acute facilities. Whatever we think about the demand for post-acute care now, it’s going to be tenfold in coming years with upcoming demographic changes.”

To meet these needs, the industry needs to look at workforce training and retention. “If you think about the millions of people in this country and the tens of thousands each day who are aging into Medicare, we’re not going to be able to hire 10,000 new workers every day to care for that population, or even some magnitude or percentage of that,” Hu says.

We will need to look to technology, analytics, and tools to help care for our aging population. But slow adoption of new technology often gets in the way. When organizations need to print out medical records and fax them to a nursing home, that’s taking up valuable time and creating an immense amount of work for staff. “You fax the pages over, they have to read through piles of pages, call the hospitals back; it’s so much of an administrative burden, and we need to eliminate those administrative duties,” says Hu. “Hours on the phone faxing, printing.”

Instead, she says, organizations should work to eliminate the manual tracking of patients and streamline communication processes to better leverage their workforce and make the most of their limited time and resources. “We have a burning need to use technology because organizations know they can’t just hire their way out of these challenges,” says Hu. “Even with better workforce retention and development, we have to look at hiring the next generation of caregivers. Much of this next generation doesn’t even know how to use a fax machine. And from the workforce perspective, given this technology-savvy younger generation, there’s an opportunity to make the team more productive.”

Heavy administrative burdens and slow processes that keep people from practicing at the top of their license present barriers to retention and recruitment at a point in healthcare when there is a desperate need to keep the people we have and bring new talent on board. “People are used to more modern tools, and to ask your workforce—especially a younger workforce coming in—to use antiquated technology on top of all the other challenges in caregiving, it contributes to burnout,” says Hu. “From an employee retention and productivity perspective, people want to work, and they want to work in environments where they feel enabled and they’re given the tools they need to be successful.”

The report sheds light on patterns we can expect to see not only persist but also accelerate. “The call to action here is how we can enable the providers and their workforce to solve these problems,” says Hu. “What these trends are showing us is, given the demand, we need to make people more productive, and there are innovations out there that can help with efficiency and staff enablement.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at