The New Hampshire Hospital Association, Home Care, Hospice & Palliative Care Alliance of New Hampshire, and the New Hampshire Health Care Association surveyed their respective memberships to examine the bottlenecks that prevent patients from accessing appropriate levels of care in a timely manner.
Conducted on November 4, 2021, this one-day survey of a sample of hospitals, home care agencies and nursing homes found at least 200 individuals were unable to access the right level of care due to many factors impacting their transition to other health care settings. Most of these individuals, who have been medically cleared to leave the hospital, are in hospital beds waiting for placement in a nursing home. Those hospital beds, during this current crisis of surging COVID-29 hospitalizations, are sorely needed for those with acute illnesses or injuries.
Barriers can include lack of available nursing homes beds or home caregivers, patients waiting for Medicaid eligibility to be finalized or for the appointment of guardians if they lack the ability to make their medical or financial decisions, or behavioral issues. The 102 individuals in the 15 hospitals reporting on the day of the survey had spent anywhere between 1-276 days in a hospital bed after being medically cleared. Collectively, those individuals represented almost 4,000 extra days in a hospital.
Hospitals account for 95% of all nursing home referrals in New Hampshire. In the survey, 20 nursing homes reported that they received 128 referrals for patients to be admitted, with only 4 patients being admitted that day. Most of the referrals could not be accommodated due to lack of staffing to open up more beds. Lack of staff means that nursing homes must restrict the number of beds they can support. The sample of nursing homes in this study showed that nursing positions, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Licensed Nurse Assistants (LNAs), had very high vacancy rates. RNs were 23.8% vacant, LPNs 15.7% and LNAs 22.5%.
“We must find ways to develop long term solutions to these issues of lack of nursing home beds due to staffing and underfunding that existed before the COVID-19 pandemic but have been magnified by the longevity and severity of the pandemic. We call upon our State partners and other stakeholders to work to find those solutions” concluded Brendan Williams, President & CEO, New Hampshire Health Care Association.
Home care agencies provide skilled nursing care, rehabilitation therapy and home health aide services to patients discharged from a hospital or nursing home, as well as long-term supports such as personal care and homemaking. The 10 home care agencies surveyed had 97 referral requests for home care services. Staffing challenges, especially the lack of RNs, LPNS, LNAs and non-medical Personal Care Service Providers, accounted for 93% of those referral requests to be denied.
Gina Balkus, president & CEO of Home Care, Hospice & Palliative Care Alliance of New Hampshire added, “Our home care members are committed to meeting the needs of as many individuals as possible, but reduced staffing limits their ability to accept new patients.”
Collectively, the survey results demonstrate how the lack of staff, delays in coverage, and the slow guardianship processes are impacting hundreds of patients in New Hampshire. Extrapolating this data to include 100% participation of hospitals, home care agencies and nursing homes over a longer period of time would reasonably demonstrate hundreds more patients in similar circumstances. Patients are spending thousands of unnecessary days in hospitals and waiting for care in nursing homes or in their own homes.
The systemic problems discussed are not new but felt more acutely today as healthcare organizations are strained by the COVID-19 pandemic. The severity of the current COVID-19 crisis is magnified by these long-standing issues and underscores the need for removing these barriers for the sake of patients, families, healthcare organizations, and the state. The State of NH, over the past several weeks, announced several short-term initiatives to support access to care including options to support hospital bed capacity, expediting licensing and background checks, and creating strike teams and guaranteeing Medicaid payments to open more nursing home beds. These efforts are appreciated and hopefully make a sizable impact in this effort to care for the patients of New Hampshire during the current COVID-19 surge. Several of the report’s recommendations seek the adoption of these short-term measures into long-term change, as well as additional investments in healthcare staffing, Medicaid coverage and reimbursement and expediting guardianship for those in need.
“We are appreciative of the collaboration with our home care and nursing home partners to develop this joint report. This report just illustrates how important all healthcare providers must be supported to ensure that our patients receive the right care, at the right time and the right place. During this time of crisis in our healthcare systems, we must continue to find ways to transition people to the best level of care”, said Steve Ahnen, president, NH Hospital Association.
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