Covid is still keeping hospitals running even as admissions remain low

Most Nursing homes are restricted new patients due to staff shortages, The average hospital stay is longer than before the pandemic.

In Washington, about 10% of patients currently in hospital beds no longer require hospital care, said Cassie Sauer, chief executive officer of the Washington State Hospital Association. Most are waiting for a place in a nursing home or psychiatric facility.

“It’s a national phenomenon,” says Sauer, who has experienced the effects first-hand. A family member’s hospital discharge was delayed after she was interested in two nursing homes closed due to Covid outbreaks.

Stephanie Schulz, a board-certified independent patient advocate, said a hospital she works with recently had 45 patients, all of whom had to be discharged within the same timeframe – and they were struggling to find appropriate care for everyone.

Another patient and his family were considering options three hours from home.

“So many people don’t want to believe that Covid is still one of the reasons, but it is,” Schulz said.

According to a May survey by the American Health Care Association, more than 60% of nursing homes are restricting admissions due to staffing shortages. Most say it has gotten worse since January.

The pandemic has “made a really difficult job even more difficult,” said Mark Parkinson, president and CEO of the American Health Care Association, as staff face “intense work” to prevent the spread of Covid.

Bureau of Labor Statistics data shows that since the pandemic began, hundreds of thousands of workers have left the nursing home industry.

And now, “hospitals just aren’t able to discharge people in the way they normally could,” he said. “They call the nursing homes and the nursing homes say we just can’t take the patient because we don’t have enough staff to take patients right now.”

In fact, patients going from a hospital to a skilled care facility required an average of four referrals in 2019 — but that number rose to an average of seven referrals in the first five months of 2022, according to data provided by WellSky, a health technology company with products that used by hospitals across the country.

These patients stayed in the hospital for an average of nine days in 2019, but are now hospitalized for an average of 10.5 days, according to WellSky data.

“In general, as a country, we’ve been working our tails off to get discharge – particularly elective surgery or pregnancy – done much, much faster and outpatient surgery levels have gone through the roof. And yet here in 2022, we’re seeing length of stay increasing in a way we’ve never seen before, even though we’ve actually done almost everything we can to reduce that number,” said Bill Miller, Chief Executive Office of WellSky.

“You see these inflated rates and I think Covid is the main culprit. It’s still working its way through the system.

Trends are changing, but Covid-19 and its impact are still not fair

Overall, just 4% of beds in the US are occupied by Covid-19 patients as hospitalizations come at one of the pandemic’s lowest points, according to the US Department of Health and Human Services.

But one in five people in the US still lives in a county that the US Centers for Disease Control and Prevention says has a “high Covid-19 community level” that is once again at risk of overwhelming the health care system.

“We urgently need free capacity if there is another increase. Patients waiting in hospitals take up an unnecessary amount of space and staff time,” Sauer said.

She estimates that hospital stays for Covid patients average around five days. If someone waiting for a place in a care home is hospitalized for more than 10 days, they are occupying space that two Covid patients could have used – and many stays are much longer.

While Covid admissions are low, the ongoing strain on the entire healthcare system is presenting many hospitalized patients with difficult choices.

Long Covid can affect children of all ages, including infants, studies show

As the refusals to release mount, “families feel like they really don’t have a choice,” says Schulz. They feel trapped in the hospital and have to take the first facility that comes along.

“Sometimes these tough decisions have to be made to forgo certain types of treatments just to get them out of the hospital,” Schulz said — even in patients with an incurable diagnosis.

Discharge delays also have an amplifying effect.

There can be such a gap between starting discharge planning for a patient and finding a place where their care needs change and the process has to start over.

“Reassessments of the level of care encompass all disciplines of the healthcare team. So they’re bringing all the providers that are working with these patients back into PT, OT, speech therapy,” she said.

And possible exposure to Covid in hospital will require patients to be held for at least a week as well.

“It’s a pretty big domino effect.” She said.

Sauer says now is the time to make adjustments.

“I don’t like that we wait until things get really bad to react – like the idea that we get to a crisis point with hospitalizations and then ask people to take corrective action,” she said.

“There are delayed supplies, it’s a nationwide phenomenon. And the people who can’t be discharged from hospitals, that’s a national phenomenon. And the lack of mental health care is also a national phenomenon. And staff shortage. So we know hospitals are stressed,” she said. “I just don’t want to wait until we get into the crisis to do something about it.”

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