With nursing homes, skilled wards and other downstream care environments locked up, emergency hospitals find it more difficult to discharge patients and clear beds for new arrivals.
The result is not just a capacity problem for facilities facing an influx of covid-19 cases, but unnecessarily longer stays that double the demand for expensive staff and supplies.
“We are discovering almost overall difficulties in discharging patients on time because the facilities we refer to have the same problems we have,” Universal Health Services (UHS) CFO Steve Filton said at this week’s JP Morgan Healthcare conference. “So, no matter what the community is, the nursing home has 20% of its beds at home, the rehab center has two floors closed or whatever because they can not find enough.”
Filton – who noted that his company also sees the lack of services in the subsequent stages of its behavioral care business – said that the traffic jam leads to a longer average stay in UHS hospitals. This, combined with the overall higher sharpness of COVID-19 patients, means that his hospital spends more on both necessities and high-demand healthcare staff, he said.
To some extent, these discharge challenges appear to have existed during the course of the pandemic, according to CarePort, the manufacturer of the referral and care coordination platform.
Referring to proprietary data from 2019 to 2021, the company said that the acceptance rate for referrals for home care has fallen by 15%, while SNFs declined referrals 10% more often in 2021 compared to 2019.
Hospitals also found it more difficult to place their patients in 2021, according to CarePort, where the average number of referrals per patient increased by 32% for those referred to the SNF, 42% for those referred to home care authorities and 15% for those referred to hospice.
But more reports are coming in from hard-hit areas in the country that indicate that emissions challenges are peaking in the latest wave.
Roxborough Memorial Hospital, a 131-bed community hospital in Philadelphia, told the Philadelphia Inquirer that there were about three times as many patients stuck in their emergency room “ready to go and nowhere to go.” Leaders from other hospitals active in the area, such as Main Line Health and Trinity Health, told the newspaper that they face similar challenges.
On January 10, the Pennsylvania Health Care Association published an emergency plan that it hopes will serve as a resource for the state government because both hospitals and long-term care facilities are short of space and staff.
“Long-term care realizes that it is once again at the center of the latest developments,” the organization wrote in a statement. “With hospitals reaching patient capacity due to increased patient intake, the capacity problem is exacerbated by the struggle to discharge patients to long-term care. Long-term care providers face enormous staffing challenges that prohibit them from accepting new residents.
In Massachusetts, Brigham and Women’s Hospital reportedly had over 200 patients waiting to be discharged to nursing homes. The Boston Globe reported in early January. More than 60 percent of state nursing homes reported intermittent admissions due to staff shortages, according to the Massachusetts Senior Care Association, which called on the state government to provide support from the National Guard.
While discharge backups are emerging in states and regions affected by omicron, national organizations are sounding the alarm about an industry trend.
Survey results from more than 14,000 nursing homes and long-term care facilities was released in September of the American Health Care Association and the National Center for Assisted Living (AHCA / NCAL) suggested that 58% of nursing homes had to limit new admissions due to staff shortages. From the beginning of the pandemic to November 2021, nursing homes had lost 234,000 employees or about 15% of the total workforce, according to the National Bureau of Labor Statistics.
On January 12, the AHCA / NCAL also warned that weekly cases of covid-19 had soared to more than 32,000 residents in nursing homes and 57,000 employees. With even more shortcomings looming, the organizations demanded government support to support their member facilities and the entire care system.
“We can not cope with this storm alone. We are extremely concerned about how this increase will affect our already serious labor crisis because caregivers must isolate themselves if they test positive,” said David Gifford, MD, chief physician of AHCA / NCAL, in a statement. “Lack of staff affects access to care for our vulnerable residents and hinders our ability to help overwhelmed hospitals.”