Hospital associations bolster care home defense as referral bottleneck grows


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

The Washington State Hospital Association (WSHA) saw an opportunity to address patient safeguards in an upcoming state legislative session, with plans to advocate for increased funding for long-term care.

“We are concerned that patients are literally living in hospitals,” said Chelene Whiteaker, the association’s senior vice president of government affairs. “When there is a patient who no longer needs to be there and who could be served in another setting, should be served in that setting and stays in the hospital, it impacts our ability as that state to be prepared for Covid surges, other disasters, as well as the cost of hospital money for which they are not reimbursed at all. »

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

Such attention holds promise for operators in an industry that has long considered itself the “ugly son-in-law” of healthcare. Advocacy means greater recognition from what care home leaders see as an impactful sector with influential associations.

“Top five lobbies, who’s in there?” The hospital association and absolutely, unequivocally, AARP, and they don’t like us,” said Lynn Hood, CEO of LTC, during a panel discussion at the LTC 100 conference last month. “I think they don’t like us because no old people want to talk about nursing homes, but the reality is we’ll still be here.”

Short-term and long-term advocacy efforts

The patient bottleneck is more of an immediate issue, with longer-term issues stemming from the need to make every part of the continuum of care work well.

“That’s one of the reasons we’re advocating for funding and advocating in partnership for policy change with long-term care partners,” added Zosia Stanley, WSHA Vice President and General Counsel. associated. “We are all advocating together for a better system will result in a better system, as opposed to advocating at the individual level.”

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

Meanwhile, the nursing shortage extends to hospital systems as well. Limited hospital beds and badly needed clinicians tend to “hard to get out” patients, creating myriad problems further exacerbated by Covid, Whiteaker said.

Bariatric patients, those with dementia, or others with very 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 cannot accept them — the salary does not cover the staffing levels required for that patient, according to Stanley.

State funding to strengthen the workforce

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

State NFCs received $26 million in 2022 to support contract nursing teams for 242 newly opened nursing home beds, according to the state budget, $22.3 million for helping facilities accept hard-to-place residents from hospitals, and $48.3 million to increase Medicaid rates, with those dollars going to low-wage direct and indirect care workers.

“Our State Legislature funded very substantial sums in the last legislative session for this long patient stay issue, and all of that was really necessary, but none of that is enough,” Stanley added. . “There are still many barriers that patients face for appropriate and timely placement.

On a longer-term note, the WA Cares Fund — passed in 2019 and delayed while lawmakers made tweaks to the law — is the nation’s first payroll tax plan to help individuals pay for care costs. long term.

The state was pushed back on the initiative once taxpayers realized the mandatory payroll withholding would be 0.58% per $100 of income. That’s a deduction of $302 each year for someone earning $52,000 a year, according to an NPR report on this point.

While there’s always an opportunity for politics to improve the state’s long-term care sector, Stanley said the biggest contributor to saving patient referrals — staffing shortages — can be solved. through increased funding and, in turn, improved rates.

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


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