Tacoma — The pandemic’s toll has not ended for many hospitals in Washington state, even with fewer COVID-19 cases to treat.
Hospitals are struggling to cope with high patient loads that are not COVID-related. According to a new report released Sept. 15, hospitals also are on track to have their worst financial year since the start of the pandemic.
Loss of staff over the course of the pandemic has left its mark. Employees have left from burnout, long-COVID or death, rejection of vaccine mandates or to earn more money as traveling staff, among other reasons.
Staffing shortage mean fewer beds available for patients. Among available beds, a growing number of patients are unable to be discharged because they have no place to go next (such as long-term care or rehabilitation centers) or there is a lack of legal guardianship to approve transfers in cases coming under state requirements. If a patient has not appointed a decision maker in a power-of-attorney document, the only option is a court-appointed guardian, which takes time, according to state interpretation of the law.
“Hospitals are struggling and will be for awhile,” Beth Zborowski, media representative for the Washington State Hospital Association, told The News Tribune via email recently.
“We seem to not be in quite the crunch we were earlier in the summer — we’re coming out of summer trauma season — but capacity is still an issue.
“The biggest factor is we still have hundreds of patients who no longer need medical care who remain in hospital beds. The whole system is backed up.”
Among nursing homes, adult family homes or similar settings, she noted, “Thousands of beds have been taken offline in these settings due to staffing shortages.”
The backup has trickled down to some emergency departments. The Kitsap Sun reported Aug. 28 that ambulances were facing sometimes hours-long delays for drop-off at St. Michael Medical Center in Silverdale, part of the Virginia Mason Franciscan Health network.
A representative for another VMFH hospital offered an update Friday in a statement to The News Tribune.
“While there’s been a decrease in COVID-19 hospitalizations, all hospitals in Washington state, including St. Joseph Medical Center, are experiencing extremely high patient volumes,” said Jennifer Schomburg, president of St. Joseph Medical Center in Tacoma.
“We are also continuously managing staffing shortages including in our emergency department, and post-acute care placement challenges, which make it difficult to discharge inpatients who are waiting for guardianship to be established.”
The health system told The News Tribune that at the end of August, “Virginia Mason Franciscan Health had 22 patients systemwide who no longer needed hospital-level care but were unable to be discharged. Combined, they have been within our system for a total of 3,458 days which represents an estimated 864 patient stays.”
It added that VMFH “has a robust hiring, recruiting, and retention plan underway to maintain our existing staff levels and recruit additional team members, including offering lucrative signing bonuses and loan forgiveness programs to attract new hires. We are also leveraging highly skilled temporary and traveler staff to address high capacity and provide respite to our tired employees as we actively recruit to fill positions full time.”
Scott Thompson, media representative for Tacoma-based MultiCare, told The News Tribune via email on Friday that its hospital inpatient volumes are averaging “around 105 percent of licensed capacity,” as the number of COVID related patients has declined since April.
“Our patient mix has shifted to medical patients that tend to stay longer,” he wrote.
MultiCare’s emergency departments are averaging anywhere from 35-60 patients daily, he noted, with its four off-campus emergency departments averaging between seven to 14 patients daily.
Zborowski told The News Tribune that July through the better part of August hospitals were in a “capacity crisis.”
“Harborview Medical Center was forced to go on divert. This was unprecedented,” she wrote.
For a brief time in August, Harborview in Seattle stopped accepting patients that were not in need of urgent care.
“Other urban hospitals were also operating above capacity and couldn’t accommodate transfers from smaller rural hospitals,” Zborowski noted.
She added, “We estimate between 10 and 20 percent of hospital beds are still being taken up by patients who are awaiting discharge to a nursing home, adult family home or rehabilitation facility. …. A patient with a 60-day stay displaces 20 acute care patients who stay an average of three days.”
She also noted that “More people are seeking care and they are sicker when they come to the hospital, so they are having longer stays.”
Thompson of MultiCare said its system In August “had nearly 200 patients across the system … unable to discharge to the next level of care due to a lack of availability of space in area skilled nursing facilities.”
Washington has historically struggled with low bed-to-patient ratio.
In a Kaiser Family Foundation ranking based on American Hospital Association’s annual survey from 2015 to 2019, Washington and Oregon were tied for the fewest, with just 1.7 beds per thousand population. The national average was 2.4.
A Sept. 15 report from financial and performance consultants Kaufman, Hall & Associates released by the American Hospital Association predicted that 2022 would be the financially hardest year of the pandemic for hospitals, with rising costs of labor, drugs and supplies, and a lack of additional COVID relief funding.
“Managing the aftermath of the pandemic has placed the vast majority of America’s hospitals in serious financial jeopardy as they experience severe workforce shortages, broken supply chains, the Medicare 2% sequester kicking back in and rapid inflation that has increased the cost of caring,” said Rick Pollack, AHA president and CEO in a statement.
A MultiCare representative in July described that health system’s financial issues in a news conference about financial strains hitting hospitals statewide. He noted it faced an operating loss of $194 million out of $300 million in total losses at that point, with the total expected to rise.
Zborowski told The News Tribune this week that In the first quarter, hospitals in Washington state lost $1 billion to increased costs.
“We do have among the fewest hospital beds per capita and our Medicaid payment rates are very low, covering only 63 percent of the cost of care,” Zborowski said. “This isn’t sustainable and we may see even greater capacity challenges if hospitals are forced to take beds offline or close services.”