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San Diego SNF Resource Analysis

July 24th 2014

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National University EffortResults of Student Research• Determining SNF health delivery capacity• What are the Skilled Nursing Care Resources

in the San Diego Community and are their GAPS in Services available?

• Investigators: Sharon Segrist, Joe Feliciano

• Internship Coordinator-Kiera Schminke, MPH

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Presentation of Results

• Methodology• Conduct of Survey• Aggregation and Extrapolation of

Data• Discussion of Results

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Methodology-Data Sources

• Utilization of Skilled Nursing Facilities– Facility register- County of San Diego

Skilled Nursing Facility Emergency/Disaster Task Force

–Office of Statewide Health Planning 2012 reporting data

– Survey Monkey Results from +58% of local facilities

– Imperial County Information

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Conduct of Survey

• Sourced from Interact tool kit used in MDS reporting and analysis

• Tested 10 key questions with SDHCA Board of Directors

• Sent out surveys• Follow up with calls and emails

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Aggregation of Data

• Regional Analysis- utilizing the County of San Diego Emergency Services Region model

• Local Hospitals in relation to skilled care facilities

• Collection of self reported data on specialty services

• Use of Extrapolation technique to draw conclusions with results

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RESULTS

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National/ State ComparisonBeds per 10,000 population

Natl State San Diego 0

10

20

30

40

50

60

Series1

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Regional Capacity

North In-land20%

North Cen-tral8%

East 38%

North Coastal12%

Central 10%

South12%

Skilled Nursing Beds by RegionSan Diego County 2014

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Occupancy by Region 2013

North In

land

North Centra

lEast

North Coasta

l

Central

South0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Series1

Skilled Nursing Facility Occupancy by Region 2013

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Relational Data

• Average number of SNFs- within 5 miles of hospital

63 %

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Unserved Communities

• These local communities have no/limited skilled nursing facilities:

• These local communities have the most skilled nursing facilities:

• El Cajon, Kearney Mesa, Escondido

Alpine North Park Rancho San Diego

Ramona Bonsall San Ysidro

Julian La Costa Point Loma

Kensington Imperial Beach Mission & Ocean Beach

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Service CapacityMost skilled nursing facilities provide:

Specialized Diet Management

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Service Capacity

Few Facilities Offer:

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How soon after admission is the patient evaluated by a physician?

24 (50.00%)

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Wound Care Services

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Pharmacy Services

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Socio-Economic Factors

• Corporation Owned facilities 32%• Privately Owned facilities-LLC’s- 52%• Non Profit Facilities 15%• Leading owner-operators in San

DiegoSHEA Family Covenant Front PorchPlum Windsor RemingtonElmscroft Brighton LifeCare

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Identified Gaps

• Few private or negative pressure Isolation Rooms

• Trach and Vent Management Programs

• Location of patient placement – close to hospital not close to family/home

• Quick Access to MD’s post admission

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Recommendations

• Conduct SNF Survey Annually• Improve Participation of Facilities in survey• Publish results in Quick Guide• Explore the expansion of the care conversation

with families, patients and primary care physicians• Explore preference to place patients in facilities

nearer to their home community• Refine the role of Hospital Case Managers and Post

Acute care management

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Dual Eligibles & other Fun

• Battle of the Case Managers to “own” the patient

• Lack of Understanding about the operational pattern of SNF nursing units

• Everyone must incorporate each other into the planning for a patient’s/resident’s care.

• Continued Care Compact

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Thank you!