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Problems persist at Washington hospitals due to lack of long-term care options

Harborview Medical Center is currently diverting non-emergent patients as the hospital copes with overcrowding. Other local hospitals face similar concerns.

SEATTLE — Harborview Medical Center reported Thursday it will temporarily accept only patients that are in urgent need of their specialized care.

The hospital said it had 560 patients in a hospital set up for 413, and that 100 of those patients are medically stable and in need of long-term, post-acute care, but have not yet been able to be transferred. 

Hospitals statewide warned about this problem in July. Hospital leaders said it persists today. 

Hospitals provide acute care - treatment for an emergent need such as a heart attack. Other facilities provide post-acute care, such as rehabilitation, or services such as memory care. 

The Washington State Hospital Association (WSHA) said many patients are waiting in hospitals to try to get that care, but face major delays.

"It's really, really challenging to find a placement in a nursing home or an adult family home right now and there's several reasons for that," WSHA CEO Cassie Sauer said. "One is that nursing homes just aren't paid enough to take care of really complex patients and, especially with the wage pressures we're experiencing from our really tight employment economy right now, it's really hard to hire people to work there."

LeadingAge Washington, which advocates for not-for-profit and mission-driven senior care and housing organizations, said current Medicaid rates make it difficult for long-term care providers to pay direct care workers livable wages. 

"Our [certified nursing assistants] in both assisted living and skilled nursing facilities' average pay has been between $16-$18 per hour, some of the lowest wages in health care," a spokesperson wrote. "Our direct care workers hold some of the most important jobs in healthcare, taking care of our state's older adults, and their value needs to be reflected in their pay and how we perceive this profession, and we will not rebuild our workforce until those issues are addressed."

The group said hospitals have always been one of their largest sources for patient referrals for long-term care and it is their mission to provide care and services for older adults who need placement and no longer need to be in hospitals, but the current workforce shortage is inhibiting them from admitting more patients.

"Some national studies have Washington as one of the top states for staffing shortages, with an estimated turnover of almost 40% for some positions, leaving long-term care providers unable to safely meet the needs of patients needing to be discharged from the hospital," a spokesperson wrote. "Our staffing shortage started long before COVID due to chronic Medicaid underfunding but has gotten exponentially worse during this pandemic because staff are exhausted, retiring, and finding employment elsewhere, and we are losing competent and caring staff."

WSHA also has concerns surrounding the state's interpretation of guardianship laws, and the time it takes for a loved one to get the ability to make decisions about long-term care in a case where a patient is not in a position to decide on their own. WSHA said some of its hospitals have reported that these issues make transfers take longer even when a bed is available.

"This is an issue that should worry every Washingtonian right now," Sauer said. "If we can't get people out of hospitals, if you need a hospital bed, you may not be able to get one."

WSHA is advocating for increased funding for long-term care facilities and reinterpretation of or new legislation surrounding guardianship laws.

Meanwhile, Governor Jay Inslee's office said agencies are continuing to work with hospitals and are in regular communication with them -- Harborview in particular -- to try and find community placement. 

The office outlined some of its strategies in a letter to WSHA.


WATCH: Harborview diverting some patients is an 'incredibly difficult decision' 


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