Covid-19’s Affect on Post Acute Care – A Sustainable Shift To the Home? | myNEXUS®

07 . 04 . 2021

COVID-19 has led to a massive shift in healthcare delivery in the United States.  This shift has impacted every sector of care, for example, the pandemic has accelerated the transition from institutional-based care to home-based care.  In an article by Robert Holly[1], he references Altarum’s 2020 data that suggests healthcare spending decreased. Surprisingly, this is the first time since 1960 that annual healthcare spending fell below the prior year’s. In all likelihood, this year-over-year reduction in spending was due to the COVID pandemic[2]. With reference to post-acute care, Altarum projects that COVID’s impact on home health expenditures increased by 2 percent while its impact on nursing home care decreased spending by 2.5 percent. COVID’s impact however was not a one-time shock to the post-acute care industry. It merely accelerated longer-term trends. For nearly a decade, nursing home spending has grown much more slowly than other healthcare sectors – its average annual increase has been 2.2 percent. In contrast, home care spending’s annual growth rate has been about 5.5 percent for the last 5 years[3]. Most analysts believe that these trends are secular and represent a sustainable move of post-hospital care from the nursing home to the patient’s home with accompanying home health care.

Several seemingly new clinical strategies that, in fact, began years ago suggest that moving care from the nursing home to the home is permanent. Hospital-to-home care began in the 1990s and has been gathering steam ever since. Urgent care in the home, a version of the long-forgotten house call, was revitalized in the 2000s. Hospice care has moved from institutional settings to the home and for the first time in 2017 more deaths occurred in the home than in a facility. The growth of telehealth, telemonitoring, and the announcement of new Medicare reimbursement policies in response to COVID-19 have encouraged this transition to home care.

The Altarum data and the clinical practice patterns described above make the clear case that care is moving consistently to the home. Having said this, however, for this move to continue, care in the home must be at least as safe as care in the nursing home. While the literature base is limited, a 2019 article published in JAMA[4] demonstrated that care in the home is less expensive than care in the skilled nursing facility (SNF) and that there was no difference in mortality or morbidity. There was however a slight increase in readmissions of approximately 5percent. Another article looking[5] at post-hospital care for lower extremity joint replacement found no outcome differences between the SNF and the home setting. Again, while the data is limited, to date there have been no major red flags to suggest that moving post-hospital care to the home will somehow be dangerous for patients.

Already the healthcare industry has come to side with this move to the home. Intermountain Healthcare and Ascension are forming the Moving Health Home Coalition with several home-based care companies including Dispatch Health, Signify Health, Elara Caring, Landmark Health, and Home Instead. The National Association for Home Care and Hospice and the Partnership for Quality Home Healthcare are lobbying CMS to update its policies to support this move to home from the skilled nursing facility. Clearly, the industry believes that care in the home is the future.

myNEXUS is actively supporting this sea change. As the nation’s largest manager of home care providers, we believe that ensuring post-acute care in the home is of the highest quality is critical to making sure that this shift of care from the institutional setting to the home is successful. We are actively partnering with our providers to create a “SNF@Home” experience that is to the same as or better than the traditional SNF experience. We believe that much more efficient and quality care can be delivered in the home.

[1] Holly, Robert. Against All Odds, Home Health Care Helped Bend 2020’s Cost Curve. Feb 18, 2021.

[2] George Miller, Corwin Rhyan, et al. Perspective: Did National Health Spending in 2020 Decline for the First Year in Recorded History? Preliminary Data Say It Did.  Altarum.  Feb. 2021. https://altarum.org/news/did-national-health-spending-2020-decline-first-year-recorded-history-preliminary-data-say-it

[3] HEALTH AFFAIRS BLOG. COVID-19 COSTS AND SPENDING NURSING HOMES COST GROWTH HOME HEALTH COVID-19 Shocks The US Health Sector: A Review Of Early Economic Impact. George Miller, Corwin Rhyan, Ani Turner, Katherine Hempstead. DECEMBER 16, 2020. https://www.healthaffairs.org/do/10.1377/hblog20201214.543463/full/

[4] JAMA Intern Med. 2019 May 1;179(5):617-623. Patient Outcomes After Hospital Discharge to Home With Home Health Care vs to a Skilled Nursing FacilityRachel M WernerNorma B CoeMingyu QiR Tamara Konetzka

[5] JAMA Netw Open. 2020 Oct 1;3(10):e2022382. Association of Discharge to Home vs Institutional Postacute Care With Outcomes After Lower Extremity Joint Replacement. Robert E BurkeAnne Canamucio Elina MedvedevaEric L HumeAmol S Navathe