Hospitals in parts of New York are treating an increased number of alternative-level of care patients, just the latest example of bed shortages and limited skilled nursing access combining to leave patients in limbo.
The problems in upstate New York mirror national trends with state-level hospital associations reporting that more and more of their services are going to patients who should be transferred to long-term care facilities. The advent of flu-COVID-RSV season is expected to bring another crush of patients.
Hospital associations in Massachusetts, New Hampshire and Nebraska have issued studies and reports this year highlighting the numbers of patients stranded in hospitals while awaiting open SNF beds. The Washington State Hospital Association lobbied last year in support of legislation there to increase Medicaid funding rates for SNFs that would increase annually instead of every two years.
The Rochester Beacon last week covered the growing situation at Strong Memorial Hospital — the region’s largest acute care facility — where the number of patients who should move to a SNF but are stuck at the hospital keeps growing. The news outlet took a deep dive into New York’s skilled nursing crisis, detailing the consequences of low Medicaid rates and staffing pressures.
Kathy Parrinello, president and CEO of Strong Memorial and Highland Hospital, said that caring for patients who should be moved to SNFs takes nearly 100 acute-care beds out of commission, which is complicating the facilities’ work with other patients, according to the report. She said they expect that population of patients requiring longer-term care due to the flu and COVID to increase.
Managing nearly 100 ALC patients in a day requires setting up a dedicated unit for them, Parrinello said. That means taking out of service some beds normally targeting coronary-care or post-surgical patients.
The root cause: a chronic shortage of nursing home beds due to inadequate Medicaid reimbursements.
The CEO of St. John’s Home, one of the largest SNFs in the region, said he had to take two floors out of service due to staffing and financial issues. St. John’s is licensed for 455 beds. It loses $125 per Medicaid resident per day, leaders said.
“Charging private-pay patients a rate more in line with the actual cost of care helps offset Medicaid losses,” CEO Charlie Runyon told the Beacon. “But at any given time … 70% of St. John’s residents are on Medicaid.”
Robert Hurlbut, CEO of Rohm Services Corp., which manages the Hurlbut Care Communities’ network of 11 nursing homes in the Rochester area, said that his facilities are licensed for a combined 740 beds, but inadequate reimbursements have forced him to keep 40 beds offline “for several years.” Hurlbut nursing homes have collectively lost $1 million in just over a year, he added.
