Hospital systems across the country are seeing a bottleneck of referrals to nursing homes, as staffing shortages have forced many facilities to hit pause on new residents.

The Washington State Hospital Association (WSHA) saw an opportunity to address the backup of patients in an upcoming state legislative session, with plans to advocate for more funding in long-term care.

“We are concerned that patients are literally living in hospitals,” said Chelene Whiteaker, senior vice president of government affairs for the association. “When there’s a patient that doesn’t need to be there any longer and could be served in an alternative setting, should be served in that setting and stays in the hospital, it impacts our ability as a state to be ready to deal with Covid surges, other disasters, as well as costing the hospital dollars that they don’t get reimbursed for at all.”

WSHA joined long-term care associations and their members, adding their voice to the call for more funding.

Such attention is promising for operators in an industry that has long viewed itself as the “ugly stepchild” of the health care world. Advocacy means more recognition from what nursing home leaders believe is a heavy-hitting sector with influential associations.

“Top five lobbies, who’s in there? The hospital association and absolutely, unequivocally, the AARP, and they do not support us — without their advocacy, real change will be difficult,” Principle LTC CEO  Lynn Hood said during a panel discussion at the LTC 100 conference last month. “I think they don’t like us because no one who’s elderly wants to talk about nursing homes, but the reality is we’re always going to be here.”

Near- and Long-Term Advocacy Efforts

The bottleneck of patients is more of an immediate problem, with more long-term issues stemming from a need to have each part of the care continuum working well.

“That’s one of the reasons we advocate for funding and we advocate in partnership for policy changes with long-term care partners,” added Zosia Stanley, WSHA vice president and associate general counsel. “All of us advocating together for a better system will result in a better system, versus advocacy at an individual level.”

This isn’t the first time Washington’s hospital association, or other hospital associations, have advocated for the skilled nursing industry — but lack of funding in the sector and how that affects the overall care continuum became a “substantial concern” over time, Stanley said.

Meanwhile, the nursing shortage extends to hospital systems too. Finite hospital beds and sorely needed clinicians are caring for “difficult to discharge” patients, creating a myriad of problems further exacerbated by Covid, Whiteaker said.

Bariatric patients, those with dementia, or others with really complex wound care are all examples of difficult to discharge patients, Stanley said.

From a financial perspective, reimbursements are so low for Medicaid patients that facilities can’t accept them – the pay doesn’t cover staffing levels required for that patient, according to Stanley.

State funding to bolster staffing

While some facilities received state financial support in 2022, more is needed in the coming year, association leaders said.

SNFs in the state received $26 million in 2022 to support contracted nurse staffing teams for 242 newly opened beds in nursing homes, according to the state budget, $22.3 million to help facilities accept difficult-to-place residents from hospitals, and $48.3 million to increase Medicaid rates, with those dollars going toward low-wage direct and indirect care workers.

“Our state legislature did fund really substantial dollars in the last legislative session toward this issue of long length of stay patients, and that was all really necessary, but none of it is sufficient,” added Stanley. “There’s still a lot of barriers that patients are facing for appropriate and timely placement.”

On a more long-term note, the WA Cares Fund – passed in 2019 and delayed while legislators made adjustments to the law – is the first-in-nation payroll tax plan to help individuals pay for long-term care costs.

The state received pushback on the initiative once taxpayers realized the mandatory payroll deduction would be 0.58% per $100 of income. That’s a $302 deduction every year for an individual earning $52,000 annually, according to an NPR report on the matter.

While there’s always an opportunity for policy to improve the state’s long-term care sector, Stanley said the primary contributor to the backup of patient referrals – the staffing shortage – can be addressed via increased funding and in turn enhanced rates.

“If you have a really complex patient, and you have a general set of rates that the facility or the organization receives, there’s no incentive to take a really difficult patient, right?” Whiteaker said. “We’ve worked on advocating that the most complex [patients] should have different payment rates, and we should pay more as a state for that type of care because it is more costly and more challenging to deliver.”

AARP, Principle LTC, Washington State Hospital Association

A Buffalo transplant living in LA, Amy has worked as a business journalist for more than two years and has been in the profession for seven-plus. She is an avid (sometimes poolside) science fiction reader, nature lover and roller derby novice.

Contact: [email protected], 312-967-0762

Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. Skilled Nursing News is part of the Aging Media Network.

© Skilled Nursing News . All rights reserved.