A public health emergency (PHE), brought on by the worldwide spread of COVID-19, was first declared in March 2020 and has been renewed every 90 days since. It was recently announced that the public health emergency will end on May 11th, 2023.
While three years have passed, and much of life has returned to normal, this will have a massive impact on the healthcare system.
Why? Emergency funding and waivers have been available throughout the PHE and have allowed the government to quickly appoint people and funds to respond to the situation quickly.
The end of the PHE means an end to emergency funding and a return to many policies and practices that were removed or waived during the emergency.
While the return to pre-pandemic methods signals that COVID-19 will now be treated as an ongoing illness (much like the seasonal flu virus), the change also means a return to fighting for funding and navigating regulatory restrictions.
Here are some of the impacts ending the PHE will have on the senior care industry.
The return of the Medicare 3-day rule
Prior to the PHE, a post-acute stay in a Skilled Nursing Facility (SNF) would be covered by Medicare if the stay is preceded by a minimum 3-day admitted stay in hospital. This rule excludes patients who were only in hospital for observation.
The suspension of this rule during the pandemic has been of enormous benefit to hospitals, SNFs and patients alike. Without downstream care facilities to easily take post-acute patients, hospitals are likely to become even more over-crowded, create more work for already overburdened medical teams, and see patient care decrease.
From a financial perspective, this means Medicare beneficiaries will be responsible for any required skilled nursing care should they not meet the 3-day rule criteria.
From a payer perspective, hospital care is also more cost prohibitive than skilled nursing care. This is one of the key drivers in the push to end the rule for good.
Throughout the PHE, one of the many PHE rules waived was one which required hospitals and SNFs to communicate certain discharge information to those in need of post-acute care.
While many rules surrounding communication and information exchange between providers were often overlooked before the pandemic, the removal of this rule required even less information to be communicated.
The return of this rule means more detailed discharge information and relevant care goals and treatment preferences must be provided to patients, families and any post-acute care facility they are going to.
In the midst of an epic staffing crisis, this rule is once again likely to be overlooked.
Staff training requirements
Because of the intense need for staff, nursing homes have been able to waive the 75 hours of hands-on training and the certification test required for Licensed Nursing Aids (LNAs). This has allowed facilities to keep their facilities running and continue to provide care.
While some states have reinstated these measures, there is a worry that a nationwide reinstatement will extend the testing and training backlogs which exist across the country for many years – hindering not only certification but career advancement in a struggling industry.
Facilities can request a waiver should there be a local barrier to training and testing, although they must prove the attempts to enroll in training, the obstacles preventing the training from taking place, as well as the facility’s attempt to find solutions.
The government made Medicaid more accessible to states during the pandemic, however, the caveat was that the states could not drop any Medicaid recipient during the public health emergency.
On May 11th, enrollees will once again be dropped should they fail to meet eligibility requirements. For seniors, this could pose a serious problem.
A senior could have moved and any notices of eligibility review may not reach them, as elderly persons with memory care needs may not open or process mail in a timely manner. As federal funding decreases, the likelihood that senior citizens will lose their coverage is a real risk.
Removal of home care funding
More and more seniors are aging at home, and the pandemic helped foster that transition with increased flexibility in home-care waivers. Home and community-based care incentives may be eliminated immediately, within 60 days or 6 months of the end of the public health emergency.
This means an end to more flexible care, an increased burden on family and friends to care for their aging loved one and an overall decrease in patient care.
The final word
Ultimately, time will tell whether the official end to the public health emergency has a positive or negative effect on the healthcare system. What is clear, is the increase in funding, access and support the PHE provided has shed light on system failures and signals change in the industry. Returning to the status quo may not be the best path forward.
What is clear is that if you have a senior in your life, wearing a mask while you are with them and testing yourself for COVID if you have symptoms is a way to ensure their health and safety as the healthcare and senior care sectors move through this period of change.