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As the omicron variant propelled some acute and post-acute settings into crisis standards of care during the latest COVID-19 surge, skilled nursing facilities are again asking themselves and their community hospitals how the two parts of the care continuum can collaborate.

Nursing home operators have continued taking residents from hospitals for a more transitory timeframe like three or four days before moving them on to home health or something similar. This in turn opens hospitals up to take on additional patients who need care.

Taking a page from what was learned after the delta variant surge, some operators have also opened COVID-only buildings to work alongside nearby hospitals, while others have wings they were able to convert into COVID-19 isolation units to achieve the same result.

Panelists Steve LaForte, director of corporate affairs and general counsel for Idaho-based Cascadia Healthcare and Bill Chase, vice president of business development for Monarch Healthcare Management in Minnesota, discussed the need for such a collaborative approach during Skilled Nursing News’ Reputation & Referral Summit on Thursday.

“Omicron, in the way it’s swept through, is precipitating more conversations in that regard,” LaForte said. “[Hospitals are] essentially full. We’re at that place, we’re talking with them, but how do we help them? How do we get staffing, how do we collaborate on staffing?”

Referrals have increased across the six states Cascadia operates in, especially in Idaho, Montana and Washington, LaForte said during the panel discussion.

Staffing, as many operators have recognized, has been the limiting factor when the referral landscape has been robust for some.

“Referrals are not the issue. It’s having staff to take care of the people, right? That’s what we’re running into. With the hospitals, we’re just trying to help them decompress,” Chase added.

Simply asking hospitals and local hospital associations what’s needed, the panelists said, can help further the conversation. It may also pay off in the future when skilled nursing providers can remind them how helpful the industry was when hospitals were over capacity.

“I think probably we’ve helped ourselves with being able to help the hospitals, especially with the COVID patients,” Chase said. “They needed to be out of the hospital, but they couldn’t go home yet. So we found a niche there to kind of help with that and hopefully down the road the hospitals will remember that.”

There’s also a potential cost benefit to a continued collaborative approach, LaForte said, noting that acute care comes at a high cost and there is a finite amount of resources to fund health care, referring to Medicaid and Medicare.

“We need to be nimble enough, to provide the care needed for acuity at a more efficient cost,” added LaForte.

Especially nimble operators are not only taking higher acuity patients but behavioral health referrals as well, LaForte said. Cascadia identified a need for behavioral capabilities at its Idaho facilities as far back as 2018.

In response Cascadia worked to get 10 of its Idaho buildings behavioral care unit designations.

Behavioral health units offer a way to increase revenue and expand care, LaForte said, as well as being another way to increase collaboration with hospitals.

“There was nowhere for [hospitals] to refer to on the behavioral side,” LaForte added. “That’s another area, when you talk about collaboration going forward, the identification and diagnosis of the spectrum of behavioral issues becomes larger and more expansive.”

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