Trends in Post-Acute Care Utilization During the COVID-19 Pandemic

Abstract

Objective To examine the effect of the COVID-19 pandemic on post-acute care utilization and spending. Design We used a large national multi-payer claims dataset from January 2019 through October 2020 to examine trends in post-hospital-discharge location and spending Setting and participants We identified and included 975,179 hospital discharges who were 65 years or older. Methods We summarized post-discharge utilization and spending in each month of the study: (1) the percentage of patients discharged from the hospital to home for selfcare and to the three common post-acute care locations: home with home health, skilled nursing facility (SNF) and inpatient rehabilitation; (2) the rate of discharge to each location per 100,000 insured members in our cohort; (3) the total amount spent per month in each post-acute care location; and (4) the percentage of spending in each post-acute care location out of the total spending across the three post-acute care settings. Results The percentage of patients discharged from the hospital to home or to inpatient rehabilitation did not meaningfully change during the pandemic while the percentage discharged to SNF declined from 19% of discharges in 2019 to 14% by October 2020. Total monthly spending declined in each of the three post-acute care locations, with the largest relative decline in SNFs of 55%, from an average of $42 million per month in 2019 to $19 million in October 2020. Declines in total monthly spending were smaller in home health (a 41% decline) and inpatient rehabilitation (a 32% decline). As a percentage of all post-acute care spending, spending on SNFs declined from 39% to 31% while the percentage of post-acute care spending on home health and inpatient rehabilitation both increased. Conclusions and Implications Changes in post-hospital-discharge location of care represent a significant shift in post-acute care utilization, which persisted nine months into the pandemic. These shifts could have profound implications on the future of post-acute care.

Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey

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Psychotropic and pain medication use in nursing homes and assisted living facilities during COVID‐19

“…As discretionary inpatient procedures paused and as nursing homes especially became a setting of last resort, new admissions were most likely individuals for whom staying at home was no longer safe. 9 , 10 Future research should incorporate clinical and functional assessment data and investigate the role of the facility and geographic factors to examine these trends in more detail.…”

Care home closure and the influence of domiciliary care supply: Evidence from England

“…In England, the pandemic was initially considered as a short-term shock to demand in the care homes market, with occupancy levels expected to return to pre-pandemic levels (National Audit Office, 2020). Nonetheless, it is also likely that the impact of the pandemic will have accelerated changes in LTC systems (Werner and Bressman, 2021). The findings in this work indicate that an increase in supply of one main form of LTC need not come at the cost of a reduction in the other.…”