Staffing, Limited Resources to Address Mental Health Remain Top Challenges for SNFs

As part of a project funded by the National Institute on Aging, researchers conducted a survey of skilled nursing facilities (SNFs) and found the majority report staffing challenges and limited resources as barriers to adequately addressing patients’ social and mental health needs. 

“Nursing home quality of care is a persistent challenge, with recent reports calling for increased reforms to improve quality and safety,” authors said in the article published in Journal of the American Geriatrics Society. Clinical approaches are not well understood or standardized for mental health or social needs either. 

Between October 2020 and May 2021, researchers conducted a nationally representative survey of SNFs and used the 23 separate care delivery approaches and 12 barriers to reduce spending or improve care for short-stay residents as primary outcomes. 

Of the 693 SNFs surveyed, 377 (54%) completed and returned responses. On average, the surveyed SNFs reported 16.8 care delivery approaches and 5 barriers. 

The most common barriers to care delivery included staffing burnout/turnover, limited resources to support patients’ mental or social needs, and/or a lack of substance use services. 

Researchers also conducted a stratified analyses by facility participation in bundled payments and found some differences in SNF characteristics such as ownership type, but note challenges and barriers were similar across all SNFs. 

The most common reported delivery approaches included care management practices such as reviewing the patient census and medication reconciliation prior to discharge. 

Per survey results, “SNFs were less likely to ensure the completion of a follow-up appointment with a primary care provider or track repeat emergency room visits.”

“Nationally, SNFs implemented a wide array of care delivery approaches, but challenges with staffing and limited resources to address patients' social and mental health needs were dominant,” authors concluded. “Individual SNFs may have limited ability to address these key barriers, so the involvement of many stakeholders across the entire healthcare system may be necessary.”

Reference:
Chen AC, Epstein AM, Joint Maddox KE, Grabowski DC, Orav J, Barnett ML. Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities. J Am Geriatr Soc. Published online March 14, 2023. doi:10.1111/jgs.18331