OLYMPIA — The Washington State Hospital Association is asking the state for help in addressing “unprecedented” capacity issues at hospitals.
Many hospitals statewide, including most on the west side, are over 100% capacity. Although hospitals in Eastern Washington have not reached the same levels yet, hospital leaders say they could soon, with many currently around 95% capacity.
The issue isn’t COVID, at least not directly. What’s causing the back up is a mixture of lack of staff and available beds and the continued challenge to transition patients into long-term care facilities. Current guardianship law in Washington requires a family member with legal guardianship to sign off before moving a patient out of a hospital. If no family member is available, the patient can use a court-appointed guardian, but that can take time as there are only so many guardians available in the state.
“We have solutions that we know will decant the system, and we need to make sure those strategies are being deployed as quickly as they can be,” said Taya Briley, the association’s executive vice president.
The hospital association is again urging the state government to change guardianship requirements for those needing to move to long-term care, fund bed readiness programs statewide, expand rapid response teams for long-term care facilities and increase support for child and adult respite services.
Briley said there are indications that progress may be made on the capacity issues “in the days and weeks ahead.”
Mike Faulk, spokesman for Gov. Jay Inslee’s office, said additional steps to address capacity will likely take legislative action.
“The governor’s office has been working on a number of these issues for a long time,” Faulk wrote in an email.
He said the governor’s office is actively engaged with legislators on the issue of bed readiness, incentives for discharging challenging patients and rapid response teams. He said their data does not point to a lack of guardianship as a significant barrier.
While the problem is not directly linked to COVID, already full hospitals are not helped by an increase of COVID cases, said Dr. Steve Mitchell, medical director of the Washington Medical Coordination Center.
“Many of our hospitals, especially on the West Side, are more strained today than really at any other point since the pandemic began,” Mitchell said.
When large hospitals in the state experience overcapacity, it hurts rural hospitals because their patients can’t be transferred to larger hospitals, Mitchell said.
Though there is some COVID-19 element, Dr. David O’Brien, at MultiCare South Sound Region, said it’s mostly caused by a demand for general medical care and a lack of beds and staff for those people.
Many hospitals have patients they could discharge to long-term care facilities or adult family homes but cannot because finding a guardian for patients can take time.
Kristy Carrington, regional chief nursing officer at Providence Swedish, said about 17% of their patients no longer require hospital care but can’t be transferred to a long-term care facility.
The hospital association has continued to ask the state to change its interpretation of the guardianship law to allow family members who are not guardians to make decisions, which could make the process move more quickly.
“We are unique in the nation in taking this position,” Briley said. “And we are feeling that pain across our health care system.”
The change in the guardianship process could come from the state reviewing legal briefings and changing its interpretation, or it could mean a legislative change, which likely couldn’t happen until the Legislature is back in session in January.
The hospital association supported a bill last session that would have eased the guardianship process some, but it did not pass.
In January, Inslee said he did not have the authority alone to change the law. Instead, he brought in another 75 guardians to help patients who may need someone to sign off to their moving to a different facility.
In addition to the guardianship issue, both hospitals and long-term care facilities are experiencing staffing shortages and a lack of funding, making it harder to transition patients to those facilities.
The state hospital association is asking for funding to allow hospitals and long-term care facilities to stand up programs to help patients who need long-term care beds.
It helps the post-acute care facilities get a bit more reimbursement for patients that need a bit more help, Briley said.
The association is also asking the state to expand rapid response teams to help provide extra staffing to long-term care facilities, which Briley said have experienced significant staffing challenges exacerbated by the COVID-19 pandemic.
Lastly, the association is asking the state to expand support for child and adult respite services, which Briley said is a population that can be challenging to care for and often needs additional staffing and funding.
The requests from the hospital association are immediate fixes, said Alyssa Odegaard, of LeadingAge Washington, which helps organizations dedicated to aging individuals. But there are long-term solutions that are needed as well, such as increasing wages and expanding training for those at skilled nursing facilities.