In Post-Acute Care, Many Prefer to Go Home


Patients are likely to continue to choose to recover at home rather than go to skilled nursing facilities, according to a new report by Trella Health.

More patients are opting for home health services over skilled nursing facilities, and a new analysis expects that trend to continue.

In an analysis of post-acute care trends, Trella Health noted an uptick in home health instructions between 2020 and 2021, while skilled nursing instructions dipped over the same time frame. In fact, the skilled nursing industry’s struggles look to continue for the foreseeable future with no end in sight, the report states.

In its 2021 Post-Acute Trend Industry Report, Trella Health also pointed to the growth of Medicare Advantage enrollment, opportunities for telehealth and projections for expansion of the hospice industry. Trella Health, based in Atlanta, Ga., provides data analytics for post-acute care providers, including home health agencies, skilled nursing facilities and hospice providers.

After a dip due to the emergence of COVID-19, post-acute care instructions rebounded to pre-pandemic levels. Between the fourth quarter of 2020 and the third quarter of 2021, post-acute care instructions rose to 52.2%, up from 51.1% during the previous four quarters.

Here is a rundown of some key findings in the Trella Health report.

Going home

After being discharged from the hospital, more patients want to recover at home, the report suggests.

Between the second quarter of 2020 and the third quarter of 2021, home health instructions rose to 24.1% of inpatient discharges, an increase of 2.5 percentage points, the report stated. During that same span, skilled nursing instructions fell to 18.6%, a decline of 2.4 percentage points.

The report noted some had concerns about skilled nursing facilities being hotbeds for transmission of COVID-19, particularly with struggles in obtaining personal protective equipment.

“Stay-at-home orders likely emphasized the attractiveness of home health rather than skilled nursing care,” the report stated.

Home health agencies need to address labor shortages to meet the rising demand of patients who want to recover at home, the report said.

Skilled nursing woes

Nursing homes suffered a drop in admissions before the arrival of COVID-19, and the pandemic has only added more hurdles.

Advocates for nursing homes say they have struggled to retain employees, a persistent problem for years. Some facilities have said they have had to freeze admissions due to staffing shortages.

Skilled nursing facilities need to sell customers on the notion that they can still deliver top-notch post-acute care and also help patients avoid readmission to hospitals, Trella Health suggests.

Even with COVID relief funds, “the decrease in admissions and increase in costs associated with the pandemic has left many agencies in precarious financial positions,” the report states.

MA is here to stay

Medicare Advantage plans, which are plans run by Medicare-approved private companies, have grown substantially in recent years, and Trella Health projects that will continue.

In fact, Medicare Advantage plans are likely to cover over 50% of Medicare-eligible beneficiaries nationwide by 2025, according to the report.

Post-acute care agencies must market themselves to Medicare Advantage plans to thrive in an evolving healthcare market, Trella Health stated in the report.

Medicare Advantage enrollment rose by 65.1% between December 2016 and February 2022, the report noted. The average annual growth in that span was 9.7%.

While Medicare Advantage plans are growing, they are more popular in some states than others. In Michigan, Florida and Alabama, more than half of all those eligible for Medicare have enrolled in MA plans. Less than 10% of eligible beneficiaries have done so in Alaska, Wyoming and North Dakota.


Telehealth usage soared after the emergence of the coronavirus. The government reported a 63-fold increase in telehealth usage among Medicare beneficiaries in 2020. It makes sense, considering many had no other options to see doctors other than virtual visits for months.

Telehealth usage has dipped a bit from the 2020 peak, but it remains far higher than it was pre-pandemic.

“This increase indicates a trend toward more acceptance of technology among Medicare-eligible patients – one that will likely continue to rise as more tech savvy patients become beneficiaries,” the report stated.

More seniors are likely to use telehealth in the future to avoid the hassle of traveling to a doctor for some appointments, Trella Health predicted. As more providers opt to offer telehealth services, they have the chance to cut their own expenses and reduce the cost for patients, the report suggests.

Much of the expansion of telehealth came due to the government declaring a public health emergency and waiving certain restrictions. Healthcare advocates are pressing Washington for reforms to allow permanent access to telehealth.

Hospices: Poised for growth

The hospice industry could see significant growth in the coming years, the report projects. Hospices were less affected by the pandemic than other providers, such as skilled nursing facilities.

Over the last seven quarters, year-over-year hospice admissions rose by an average of 4%. The consistent growth, coupled with an aging population, “suggest a hospice industry primed to expand significantly over the coming decade.”

The oldest members of the “Baby Boomer” generation are 77 years old, which is approaching the average age of hospice patients: 82 years old. Hospices can help patients avoid the higher expenses patients typically rack up at other facilities, the report noted.

Hospice organizations should be preparing for an uptick in demand now by working to recruit and retain staff, the report suggests.

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