Skilled Nursing Facilities: The Missing Pillars of the Health Care System in Pakistan

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Afsha Awal Khan

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The recent COVID-19 pandemic highlighted the loopholes in the health care system across the world. In developing countries, expenditure on health care is comparatively very low and the health care system is continuously under experiment, the concept of managed health care is still a dream.1 Burden is always in tertiary health care settings. In Pakistan, major teaching hospitals serve as primary and secondary healthcare facilities as primary healthcare centers are not fully functional. Consequently, tertiary hospitals always have a shortage of beds for acute conditions because it takes patients from one end and is not able to release patients at a similar rate.2 The major reason for this is a missing pillar called ‘skilled nursing facility or ‘nursing homes. A skilled nursing facility can accommodate patients who are in transition of care and do not require hospitalization as well as are not able to be shifted to homes safely. Therefore, governments should not only functionalize primary and secondary health services to decrease admissions rates in tertiary care hospitals3 but should also focus on the development of skilled nursing facilities and nursing homes. This will ease the transition of care from hospital to home, it will also decrease the length of stay and improve bed occupancy in acute care settings.4 According to the Pakistan Nursing Council (Amendment) Act, 2020, the scope of services for specialized nurses and Advanced Nurse Practitioners is extended to prescription with an advanced level of education and competence. Master qualified Nurses with advanced specialized patient management knowledge and skills can lead and run nursing homes or skilled nursing facilities. Evidence suggests that the contribution of nurses in advanced practice in specialized care settings not only increases the level of patient satisfaction with care and treatment, but it also decreases the average length of stay, and mortality rate.5 The cost of skilled nursing homes as compared to acute hospital beds is less than thirty per cent which means it may positively affect health care economics along with the provision of quality and safe care.6

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