Washington hospitals full as patients aren’t able to get into nursing homes

Washington’s COVID numbers have come down since the delta surge of the summer and early fall, but once again, the state’s hospitals are pushing their capacity limits.

“Our hospitals are bursting at the seams,” said Washington State Hospital Association Executive Vice President Taya Briley at a briefing on Monday. “Several major hospitals and health systems are at or near 120% occupancy levels.”

This time, however, COVID-19 is not the reason for the crowded hospital rooms. Instead, patients who are medically able to leave the hospital are stuck in hospital rooms because they cannot be discharged to a long-term care facility.

“Remarkably, [the hospital rooms] are filled with patients who do not need hospital care,” Briley said.

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Just like in the midst of the delta surge, this is resulting in incoming patients having nowhere to go. Briley said some are spending days in the ER as they wait for a hospital room. This has hospital leaders worried about what could happen if there is another winter COVID surge like last year — especially with the new omicron variant circling.

“The severe shortage of hospital inpatient space is already delaying procedures that are vitally important to the health of our community members — for example, heart procedures or cancer surgeries,” Briley said.

Some patients get held back from entering rehab after a hospital stay by red tape. Briley explained that while it can be fairly straightforward for a family member to give consent for their loved one to have surgery, it is an entirely different story when it comes to authorizing their relative to go to a nursing home.

“State law for family consent to long-term care placement is remarkably complex,” Briley said.

WSHA plans to work with state legislators in the upcoming session to simplify those laws.

“We hope we will see some legislation advance during the session that will improve the decision-making process that will be able to move these patients faster into care settings,” Briley said.

Staffing is another major issue. Like hospitals, long-term care facilities have suffered staffing shortages throughout the pandemic, as employees leave due to burnout, child care needs, or concerns around catching the virus.

“Some of the [long-term care] facilities are half-full or nowhere near a sustainable level because they don’t have the staff to accept patients,” said Zosia Stanley, vice president and associate general counsel for WSHA.

That leads back to the hospitals in a domino effect, as the patients who are ready for rehab are stuck in a holding pattern until space can be found.

“The whole health care system has to work in order for any part of it to work … staffing challenges are across the health care system,” Stanley said. “And we are continuing to partner with all the different pieces and the Legislature to find a way forward.”

From hospitals to nursing homes

This comes as a recent report from the National Consumer Voice for Quality Long-Term Care has named Washington as a state without adequate long-term care staffing standards.

The report notes that other states have stronger requirements than Washington to ensure quality care — such as the number of direct-care hours that must be given to each resident each day in tasks such as bathing, dressing, and feeding. While Washington state law requires 3.4 direct care hours per resident each day, the report notes that four hours is considered the minimum for quality of life.

“In Washington state, there are definitely facilities that meet [four hours] and exceed that, but the vast majority are below that,” said Washington State Long-term Care Ombuds Patricia Hunter.

Furthermore, Hunter noted that the long-term care mandates Washington does have — including not only the direct care hours stipulation, but also a requirement to have a registered nurse on-site at each long-term care facility 24 hours per day — are on hold during the pandemic.

When facilities don’t meet these standards, it may mean people wait for hours for help getting out of bed or getting dressed. The Ombuds Office has gotten reports of falls, cold meals, lack of activity and physical therapy, and people sitting in their own waste as they wait for aid to go to the restroom.

Hunter believes Washington’s high turnover in long-term care staffing — a problem even before COVID — may have been why some facilities had such a struggle with controlling infection during all of the nursing home outbreaks at the beginning of the pandemic.

“If you have high turnover in staffing — and Washington state has one of the highest rates of staffing turnover in nursing homes, for decades they’ve had it — you don’t have the skills and knowledge, institutional knowledge, that is consistent,” Hunter said.

She sees higher pay for long-term care workers as the only way out of the problem.

WSHA agrees — and to that end, is pushing for increased Medicaid payment rates for long-term care facilities.

“That in turn can be translated into higher wages for those who work in nursing homes,” Briley said. “Nursing home care is challenging — it’s labor-intensive.”

If you are wondering if a long-term facility is right for your loved one, the Ombuds Office recommends you ask the facility for their most recent state inspection reports. You can contact the Ombuds Office for help with this. The Ombuds Office is also looking for volunteers to go to nursing homes and assess the quality of care being given.

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