The Ongoing Challenges of Long-Term Care Placements

Bilal Ahmed, M.D.

Placement of ALC patients has long been a challenge in the healthcare industry because of the low reimbursement rates by Medicaid to Nursing Homes, and the issue was made worse by the COVID-19 pandemic. Many of our patients are medically ready for discharge to a post-acute care provider, such as a skilled nursing facility. However, there are a limited number of staffed long-term care beds in Monroe County, leading to placements further away, or in a facility that isn’t the first choice of the patient or family.

Making the decision to place a loved one in long term care is never easy. With Highland’s large population of geriatric and alternate level of care (ALC) patients, it’s a decision providers and staff are often a part of. Given the ongoing challenges of placement, it’s understandable that many of us may feel distressed by our patients’ placement options and their eventual placement locations.

Today, due to the severe labor shortage created by the pandemic, many skilled nursing facilities are still unable to recruit and retain the staff they need. Currently there are 800 unstaffed, licensed SNF beds in Monroe County. Conversely, the number of ALC patients that are medically ready for discharge remains steady, which can often lead to a backup of patients in hospital beds when they are critically needed for other patients.

An unfortunate result is placement in a skilled nursing facility that is not the patient’s family’s choice, or one that is outside of Monroe County, making it challenging for families to visit their loved ones. “When a patient is medically ready for discharge, and they have an offer for placement in a long-term care facility, they have limited recourse if they would prefer another facility,” explains Sally Rousseau, Highland’s Director of Social Work and Care Management. “Some patients may try to appeal, but that appeal is only about their medical readiness for discharge, not the facility.” This can be challenging for the family, and for their caregivers.

Work is underway in the Rochester community to address the complex issue of ALC placement, including improving patient flow, improving staffing levels in post-acute care, and increasing resources to support necessary care transitions. Three main programs are currently supported by a $23.9 million ARPA grant, led by Finger Lakes Performing Provider System (FLPPS), a local non-profit that seeks to bridge the gap between community and healthcare. These programs include a Complex Care Transition Program, a CNA/LPN/RN Career Pathway, and a Home Health Aid Training Program. Most impactful to Highland is the Complex Care Transition Program, launched in November 2022, which brings resources to the skilled nursing facility setting and supports the transitions of high-need patients, who may have difficulty finding placements, from acute care hospitals.As of June 30, 466 difficult to place (DTP)patients have been placed from all Monroe County Hospitals. As of July 10, there are 99 DTP patients awaiting SNF/LTC placement.

While work is ongoing to solve the issues of ALC placements, it’s important for Highland staff and providers to support bed offers that are provided. We need our medically ready patients to be discharged so that other patients in need of acute care can receive it. While the majority of bed offers are desirable to our patients, unfortunately some are not. And while we are working at a community level to resolve the shortage of beds, it’s helpful to have our providers and staff support our placement efforts so we can make room in the hospital for acute patient care.

7/1/2023