The labor shortage roiling American industries from restaurants to retail stores is now stressing the health care system, causing a ripple effect among Washington hospitals of severe overcrowding.
The state’s hospitals are at near maximum capacity, forcing administrators to shuffle patients to other facilities, cancel surgeries and fill hallways with rented beds.
While the delta variant of the coronavirus is adding to the burden, hospital administrators say the overcrowding is driven by a pre-coronavirus problem that was exacerbated by the pandemic: they can’t find suitable places to discharge some patients who no longer need hospital care. Nursing homes, in particular, are understaffed and accepting fewer patients, forcing state officials last week to announce a series of measures aimed at easing placements.
Patients with dementia and mental illness, those without families, and people recovering from COVID-19 are among those being turned away by short-staffed long-term care facilities.
The pressure is not just on the back end — hospitals are treating more patients as well. Those who were afraid to see a doctor during the pandemic are returning for procedures, and COVID-19that patients, nearly all of whom are unvaccinated, are being admitted at the highest rate since January, according to Department of Health statistics.
Unlike in Texas and other states where the delta variant wave is overwhelming hospitals, Washington’s health care system has so far been able to transfer the sickest COVID-19 patients around the state so no facility is crippled, administrators said. Coronavirus patients occupied 11% of the state’s hospital beds during the week ending Aug. 10, the highest level since January, when it was at 16%.
By comparison, 18% of Harborview Medical Center’s inpatient beds were filled last week with patients who no longer needed to be hospitalized, interim CEO Sommer Kleweno Walley told county officials in an email obtained by The Seattle Times.
“The COVID waves have come and gone, but our facilities have stayed full despite that,” said Dr. David Carlson, chief physician officer of MultiCare, which operates eight hospitals across the state. “The biggest challenge we’re facing is the discharge of patients that no longer need care.”
As they fill up, hospitals are juggling their depleted staff, paying overtime and converting single-patient rooms into doubles.
Administrators say they are coping with the pressure, and not turning away patients. “We are still fully functional and providing ongoing care to any patient,” said Mark Taylor, associate administrator at Harborview.
On August 11, Harborview had more than 500 patients in beds, an “unprecedented” number, Kleweno Walley told the county officials. The hospital is licensed for 413, but can add beds to handle surges.
Because of the strained capacity, patients across the state have to wait longer in the emergency room, or other parts of the hospital, such as postoperating rooms, until they can be placed into a bed. In some cases, hospitals have had to reduce the number of beds they can staff, further stressing the system.
One out of every five hospitals in the state reported an average occupancy of 90% or more for the week ending Aug. 13, according to federal data. Once hospitals exceed around 85% they will urgently triage beds, canceling surgeries and transferring patients, said Cassie Sauer, president of the Washington State Hospital Association.
Health care professionals, like restaurant workers, have widely left the industry or thought about doing so during the pandemic, recent studies have shown. They’ve been exposed to the coronavirus, laid off, furloughed and subjected to long work hours.
Lower-level nurses were particularly likely to leave, a survey by the Washington Center for Nursing found this year. In total, 40% of 418 polled licensed nurses made a career change out of nursing for better pay or working conditions, the survey found.
“Hospitals have enough physical room,” said Sauer. “They don’t have the staff … People are burned out.”
Washington health care facilities are struggling to bring in temporary nurses from other states for a number of reasons, Sauer said — both structural and pandemic-related.
The state doesn’t honor health care licenses from other parts of the country, for instance. Also, Texas and other states facing COVID-19 surges are offering large incentives to lure travel nurses, Sauer said. And immigrant workers — who make up a substantial portion of the health care workforce — have struggled to travel during pandemic restrictions.
Those who leave one part of the industry — assistants in nursing homes, for example — have a ripple effect that jams up hospitals. With fewer beds available in rehab facilities, hospitals have been forced to hold onto patients who are stabilized and ready to move on.
“Difficult to discharge”
The patients that state health officials label “difficult to discharge” have been a source of consternation for years. A state health care panel in 2019 found a litany of problems with Washington’s system: a shortage of stabilization beds for people in mental health crises, a lack of coordination with insurance companies, low reimbursement rates for nursing homes, and staffing shortages, among others.
Often, these patients require more staffing than usual. They may be addicted to opioids or have traumatic brain injuries or histories of assaulting health care workers. Some are homeless. Others have no family — or their family won’t take them in.
“The ‘difficult to discharge’ residents are difficult to discharge for a reason. Usually the reason involves behavioral problems that can require one-on-one oversight,” said Robin Dale, president of the Washington Health Care Association, which represents nursing homes and other long-term care facilities.
State health agencies have been running a program to assist hospitals struggling to discharge particular patients since 2016, but last week they announced a handful of initiatives aimed at relieving the mounting pressure.
The Health Care Authority and the Department of Social and Health Services are offering skilled nursing facilities one-time payments of $6,000 each time they admit Medicaid patients, or patients who are covered by both Medicaid and Medicare. Skilled nursing facilities will get a $100-a-day bonus for Medicaid patients.
DSHS is also returning to a strategy used early in the pandemic, restarting its “strike teams” of registered nurses and other health care workers who temporarily work in long-term care facilities with staffing shortages. And the state has directed managed-care organizations, which coordinate care for Medicaid patients and others, to respond to hospital requests for placement within 24 hours. Previously some requests languished for days, said Sauer from the hospital association.
The directives and incentives may not be enough, said Dale. He said DSHS needs to assure nursing homes that the agency will help “transition these residents into the community,” into places like adult family homes or supporting housing, which can offer more individualized services.
Dale also said the state has offered a $3,000 incentive to assisted living facilities to take these patients from hospitals, but because Medicaid reimbursements already fail to cover staffing expenses, “it is unlikely that this will be enough to attract interest from assisted living providers.”
Until the problems are solved, hospitals will keep rolling beds into unused spaces and stretching out emergency room waiting times.
One administrator even suggested the state set up tents to house some of the patients who aren’t too sick — “like a state with hurricanes, where they sometimes have to evacuate long-term care facilities.”