Limited nursing home beds force hospitals to keep patients longer

MARY LOUISE KELLY, HOST:

Caring for someone with dementia is difficult. When family members become overwhelmed, many turn to skilled nursing facilities. Staffing shortages nationwide have severely limited the number of nursing home beds available, though. That has forced hospitals to keep patients longer. Vermont Public's Nina Keck reports.

NINA KECK, BYLINE: Kathy Dick is a retired nurse who lives in Sudbury, Vt. She remembers when she first began to worry about a close friend.

KATHY DICK: She was taking a couple of us out for lunch, and she couldn't figure out how to pay the bill.

KECK: Her friend was in her mid-70s, had no children and lived alone. Signs of dementia became more frequent, and Dick worried because her friend also had diabetes and hypertension.

DICK: And it became obvious to me that she was not functioning well and just was deteriorating before my eyes.

KECK: Her friend ended up in the emergency department multiple times, and long-term care became the only option. But finding an available bed took months. Meanwhile, her friend stayed in the hospital. Kathleen Boyd says this is not a new problem. Boyd directs care management at Rutland Regional Medical Center.

KATHLEEN BOYD: This is a growing concern not just in Vermont but all over the country because people are living longer.

KECK: She says on any given day, they have five to 10 patients waiting in the hospital for long-term care. Not all have dementia. Some have serious psychiatric disorders or are impaired because of substance abuse or traumatic brain injury. Some may have been homeless, incarcerated or violent. Boyd says they come to the emergency department for valid reasons. But once they're stabilized, she says insurance won't pay for their care anymore. And long-term care is hard to find.

BOYD: Because the facilities will look at the documentation, and they will say, we don't have the staff to be able to monitor and manage this potentially agitated individual.

KECK: While nursing homes can say no, hospitals can't. Many end up caring for patients like this for weeks, months, sometimes even years. With little to no reimbursement, it's costing hospitals millions and pushing up health care prices for everyone.

STEPHEN LEFFLER: It's a huge, huge issue.

KECK: Dr. Stephen Leffler is president of the University of Vermont Medical Center.

LEFFLER: I was on one of our floors on Friday rounding, and more than 40% of the patients on one floor were all waiting for nursing home placement.

KECK: That means fewer beds are available for others needing hospital care.

LEFFLER: I'm an ER doctor by training. Nothing bothers me more than people who - their doctor has said, you need to go to the academic medical center. And we've said, yes, you do, but we can't take you right now. For most of my career, that almost never happened. It happens every single day now.

KECK: And it's happening at hospitals all over the country. More than 30 medical organizations, including the American Medical Association, wrote an impassioned letter to President Biden last month, calling the situation a public health emergency. Low wages and workforce shortages exacerbated by the pandemic are at the heart of this problem. Many skilled long-term care facilities have had to hire more costly traveling nurses, straining already tight budgets. That's forced many nursing homes to take beds offline. Medicaid pays for the majority of nursing home patients in the U.S., and a number of states have increased reimbursement rates and provided additional funding. But so far, it's not enough. For NPR News, I'm Nina Keck in Chittenden, Vt. Transcript provided by NPR, Copyright NPR.