In Case You Missed It: Nursing Home Staffing Shortages Causing Hospital Backlogs

​Seniors are waiting days, weeks, or even months in hospital beds due to a historic labor crisis in long term care. Nursing homes are having to limit new resident admissions because of ongoing staffing shortages. This is creating a ripple effect on our nation’s hospitals. Hospitals face significant backlogs and capacity issues because patients who are ready to be discharged and need to recover in a nursing home are unable to find care. The growing crisis would be made worse if the Biden administration implements a federal minimum staffing requirement for nursing homes, as outlined by the President earlier this year. 
Modern Healthcare reports:
“Experts say skilled-nursing facilities and home health facilities have been hit the hardest by staffing troubles. The healthcare technology company WellSky analyzed data from federal agencies, more than 1,000 hospitals and 130,000 post-acute care providers on referral rejection rates, which measure how often post-acute care facilities deny admission to patients being discharged from the hospital.
“In the first quarter of 2022, the rejection rate in skilled-nursing facilities climbed to 88%. For home health providers, the rate increased from 49% in the second quarter of 2020 to 71% in the second quarter of 2022.”
The Modern Healthcare article continues:
“In Massachusetts, post-acute care discharges can be delayed for months, said Adam Delmolino, director of virtual care and clinical affairs for the Massachusetts Health & Hospital Association …
“ … [A]s of May, the last time the Massachusetts Health & Hospital Association issued a public report, 1,066 patients awaited discharge from 44 hospitals. Of that group, 672 were waiting for spots in nursing home beds, 105 for beds in long-term acute-care hospitals or inpatient rehabilitation facilities and 289 for home health services.
“The need has been so great for our hospitals to find placements for our patients,’ Delmolino said. Despite the state’s efforts, ‘the number of patients who fall into that bucket continues to increase,’ he said.
“In Washington, patients are waiting three months on average to be discharged into a post-acute care setting, said Cassie Sauer, president and CEO of the Washington State Hospital Association. In extreme cases, they wait up to six months.
“We would have plenty of room if we could move these patients out. It would be like creating multiple new hospitals,’ Sauer said.”
Here are other examples of backlog challenges:

  • In Pittsburgh, Pennsylvania, Becker’s Hospital Review reports that Allegheny Health Network discharges between 100 and 250 patients per day, approximately 10 percent of which go to skilled nursing facilities. Discharge delays have lasted up to five days because some hospitals cannot find open nursing home beds for patients. Vicenta Gaspar-Yoo, MD, president of Allegheny Valley Hospital in Natrona Heights said, “It happens all the time … We have no choice but to keep the patients." 

  • The Seattle Times reports that Harborview Medical Center continues to care for nearly 100 more inpatients than its licensed capacity because it is struggling to discharge patients who don’t need hospitalization but still need significant care. In August, the hospital had 562 inpatients and was forced to send less-acute patients to other area hospitals. Harborview Medical Center CEO Sommer Kleweno Walley said, “We had literally no further place to board patients … The next car wreck that needed to come in, we could not care for at that point.” 

  • Healthcare Dive reports, “Providence, one of the largest nonprofits in the U.S., said discharges to skilled nursing facilities have proved most challenging, especially in states with chronic deficiencies in available beds that’s now compounded by a declining workforce.” Its average length of stay in the first six months of the year was 5.85 days, compared to 5.62 days in 2021. A Providence spokesperson told Healthcare Dive, “We feel this problem requires some level of intervention by state and federal authorities to create the necessary relief in service to our communities. The need is massive and urgent.” 

A federal staffing mandate will not solve staffing shortages but instead exacerbate current challenges for nursing homes and hospitals. Nursing homes need funding and resources from the federal government so they can recruit and retain more caregivers. Policymakers must support, not mandate, rebuilding the long term care workforce to ensure our most vulnerable citizens have access to the care they need.