Staffing Shortages, Skilled Unit Closures Slowing Discharges at Pittsburgh (PA) Hospitals

By Kris B. Mamula

Pittsburgh Post-Gazette

(MCT)

Getting admitted to a hospital is usually a pretty straightforward affair.

Getting out of one, especially if you have complex medical needs, can be a different matter entirely.

Discharging patients from hospitals has slowed at a time of widespread labor shortages in health care. Not enough staff at nursing homes — where many patients go from the hospital for rehabilitation — is the new bottleneck, officials say.

Even ambulance services are having staffing problems, representing more delays in patients getting where they need to be.

“It happens all the time,” said Vicenta Gaspar-Yoo, president of Allegheny Health Network’s Allegheny Valley Hospital. “We have no choice but to keep the patients.”

Systemwide, AHN discharges between 100 and 250 patients a day, with about 10% going to skilled nursing facilities, Dr. Gaspar-Yoo said. Delays have lasted up to five days in finding open nursing home beds for patients no longer in need of the acute care in a hospital.

The story is the same at UPMC, which operates 40 hospitals, mostly in Pennsylvania.

“Usually every day, we have patients who are good to go back to a nursing facility and they’re here the next day,” said Susan Hoolahan, president of UPMC Passavant Hospital and a registered nurse for nearly 40 years. “There are times we have patients with us months and months that just can’t get placed” because they have complex medical or behavioral health needs.

“There’s just no place for them,” she said.

Inflationary pressures, sharply higher labor costs and stagnant government reimbursement have stressed Pennsylvania’s 700 nursing homes where more than 80,000 seniors live. The result: 17 skilled nursing facilities have closed in Pennsylvania over the past two years, including ones in Baldwin, Squirrel Hill and Oakmont, while others have left beds empty because temporary staffing costs are too high, said Zach Shamberg, CEO of the Pennsylvania Health Care Association, a Harrisburg advocacy group.

“The workforce crisis is preventing providers from accepting new admissions,” Mr. Shamberg said.

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A recent PHCA survey found that 75% of Pennsylvania’s nursing homes were operating in the red. Inflationary labor costs of temporary staff were a big reason.

Adding to the uncertainty of finding a nursing home bed was a recent strike vote taken at two dozen nursing homes by members of SEIU Healthcare Pennsylvania, including facilities in Beaver, Washington and Westmoreland counties. A walkout could come Sept. 2, the union has said.

Among skilled nursing beds that have been taken out of service in the Pittsburgh area in recent years were two 18-bed units operated by Paramount Health Resources Inc. in Peters and Baldwin. Oakmont Center for Nursing & Rehabilitation also closed, along with the Charles Morris Home in Squirrel Hill and skilled nursing units at UPMC McKeesport and Butler Memorial hospitals.

“It’s a staffing issue,” said Paramount chairman and CEO James Cox, who described the industry’s labor issues as the most difficult since the 1980s. “Finding a nurse, a nursing assistant is just impossible. It’s horrific.”

Government reimbursement that was too low was Butler’s reason for closing its 25-bed skilled nursing unit in July 2020, said Karen Allen, chief nursing officer.

“It got to the point it was losing a lot of money for us,” she said. “Behavioral health patients, especially patients with chronic medical conditions who can’t live independently, there’s no place for them to go anymore. It’s terrible.”

Hospital case managers can call dozens of nursing homes before finding one that will take a patient, Ms. Allen said, which delays their release. “We’ve had them stuck here 30 days,” she said.

For families, that can mean having to drive farther than expected to visit loved ones. It could also erode hospital revenue because Medicare and commercial insurers usually pay a flat rate for care, regardless of how long the patient stays or how much care is provided.

But finding a facility can be just the start of the problems: Scheduling an ambulance to move the patient to the new facility is an issue that’s “becoming acute,” Ms. Allen said.

Industry insiders say ambulance positions have become stepping stones to better paying careers in nursing in recent years, often leaving paramedic and emergency medical technician jobs unfilled.

In July, Gov. Tom Wolf addressed the nursing home funding problem by increasing reimbursement by $300 million a year for people on Medicaid, the first increase in nearly a decade, for a 17.5% increase or about $35 per resident per day, according to Skilled Nursing News. Union and long-term care industry leaders helped broker the increase.

In the meantime, health systems are continuing to move services out of medical institutions, chipping away at the need for nursing home care.

AHN corporate parent Highmark in April created Helion, a subsidiary, to expand the kinds of medical care that can be delivered in the home through the use of analytics and better coordination.

“There will always be a need for an in-patient facility,” Helion Vice President Nick Stupakis said. “But we are shifting more capabilities into the home.”

Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699.

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