Nebraska hospital leaders on Wednesday highlighted an ongoing problem: the inability to discharge certain patients to post-acute facilities for care.
According to a report from the Nebraska Hospital Association, there were 227 patients awaiting a discharge last month, nearly half of whom have been waiting a month or more.
The issue is not a new one, but it's one that's gotten a lot worse in the past couple of years due to a number of factors.
Jeremy Nordquist, president of the Nebraska Hospital Association, said the organization started tracking the number of patients awaiting discharge in September and found there are hundreds of them every month.
Nordquist said the challenge has continued to grow and, "it's reaching the point of a crisis."
People are also reading…
He said the inability to transfer patients who no longer need acute care has a trickle-down effect that leads to more people having to be boarded in emergency rooms and fewer accepted transfers of patients from smaller hospitals to larger hospitals.
The causes of the problem are myriad and often include short-term issues such as a COVID-19 infection or insurance delay. But there are also longer-term structural issues, and two of the biggest are nursing home closures and staff shortages.
According to the Hospital Association, 35 long-term care facilities and 27 assisted-living facilities have closed in Nebraska just in the past five years. Data from the Centers for Medicare & Medicaid Services shows nine nursing homes closed in the state last year, second most in the country, behind only Texas.
The vast majority of the facilities closing are in rural areas of the state. According to the Hospital Association report, of the 62 closures in the past five years, 55 of them occurred outside of Douglas and Sarpy counties.
Mel McNea, interim CEO of Regional West Health Services in Scottsbluff, said nursing home closures have hit hard in rural areas, especially in western Nebraska.
The closures combined with staff shortages mean nursing homes are less likely to take patients who need high levels of care, such as those with dementia or people needing dialysis.
McNea said Regional West used to discharge patients with memory issues to a facility in Fort Morgan, Colorado, about two hours away, but it closed.
"So that makes it more difficult to place those patients," he said.
Melinda Kentfield, vice president and chief nursing executive of Methodist Fremont Health, said it's not just the centers that have closed but facilities that have to operate at less than capacity because they can't find enough staff.
For instance, Methodist operates a nursing home with 106 beds in Fremont that's attached to the hospital, "But today they're at 71 (beds) and that's what they can staff and staff safely," she said.
Staff shortages also make facilities reluctant to take patients with additional needs, such as patients who can't walk on their own or those who need constant one-on-one supervision.
Nordquist said one solution that needs serious consideration is more money from the state and federal government.
Of the people waiting on a discharge in January, about three-fourths had insurance from either Medicaid or Medicare, which often don't pay enough to cover facilities' costs.
A January report from the Medicaid and CHIP Payment Access Commission found that in 2019, Medicaid payments covered only 58% of the actual cost of care at Nebraska nursing homes, tying with Nevada for the lowest rate in the U.S.
According to the report, 99.4% of nursing facilities in Nebraska recouped less than 80% of their costs from Medicaid, the lowest percentage in the country.
Nordquist said Medicaid and Medicare rates are not keeping up with rising costs and need to be increased.
"If we have provider rates that don't keep up with costs, it squeezes down on capacity," he said.
In addition to increased rates, Nordquist said nursing homes need incentives to take on more difficult-to-place patients.
He highlighted about a half dozen legislative bills this session that seek to deal with the issue in various ways, including offering incentives to nursing homes that accept patients who need higher levels of care, allowing Medicaid to pay for long-term acute care and improving the state's guardianship laws.
Nordquist said it's vital to make progress on the legislative proposals and to get higher reimbursement increases.
"We cannot just throw up our hands and say it's too complex," he said.