It was a watershed moment when the muscle-bound hospital lobby recently started advocating for better payment for nursing homes. 

Watershed, if not entirely virtuous, for there is plenty of self-interest in the gestures the hospitalists have been making. They have found themselves backed up like the constipated glutton after Thanksgiving dinner due to not enough long-term care beds to discharge medically cleared patients to.

It’s been a predicament we’ve heard about for a while. But not until Thursday have I seen it illustrated with such jaw-dropping numbers and clarity.

This is the kind of stuff that the nursing home lobby should be force-feeding to lawmakers and regulators three times a day and then again for dessert before bedtime. 

Rule-makers and budget designers should listen with every millimeter of their ears, too. What’s happening is a travesty for the system, patients and taxpayers, who fund most of the implausible scenarios.

We turn to the Granite State for illumination. A New Hampshire Hospital Association study points out that on a sample day in June, 79 patients who had been cleared to leave the hospital instead had to remain in beds they didn’t need. They had totaled a cumulative 7,455 days through their respective unnecessarily long stays.

I challenge anybody who complains about the high cost of a nursing home bed to try to keep their lunch down when they find out how much exponentially greater the cost of an occupied hospital bed is.

We all have heard stories of acquaintances who have rung up hospital bills of $50,000 or more for short stays, and not necessarily complex conditions. 

Running on empty

More than half of the 79 stranded patients cited above — 45 of them — had been waiting to get out of the hospital for more than 100 days. Worse, five of them were there for more than 300 days. Lack of nursing home space wasn’t the only reason, but it was the most commonly cited.

Even the most math-averse among us can see that’s not a good use of taxpayer — or anyone’s — dollars.

Yet here comes the federal government making it even tougher for nursing homes to operate at full capacity and alleviate hospital back-ups. The logjams aren’t happening just in New Hampshire, either, but nationwide. With the feds imposing the first-ever federal staffing mandate and more regulatory demands, nursing home staffing shortages are predicted to become even more dire. 

The nursing home lobby has predicted more facility closings and service shrinkage potentially affecting an additional 290,000 would-be nursing home patients.

All this at a time when the need for more nursing home beds, not fewer, is starting to explode as baby boomers age.

Turning back to the logjam in hospitals, their back-ups have meant that patients are also being kept in emergency rooms longer than necessary. 

Is this any way to run a healthcare system?

James M. Berklan is McKnight’s Long-Term Care News’ Executive Editor and a Best Commentary award winner in the 2024 Neal Awards, which are given annually for the nation’s best specialized business journalism.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.