Philadelphia-area hospitals are jammed with patients, but not always because they are truly sick enough to be there.
Staff shortages at nursing homes and home-care companies, difficulty finding dialysis slots for COVID-19 patients, and even a lack of space in city homeless shelters are forcing hospitals to keep patients who should be discharged.
The upshot is that emergency departments effectively have become inpatient units, sometimes even housing patients who need intensive care.
For the last week or more, 25% of Roxborough Memorial Hospital’s patients have been stuck in the emergency room, “so we only have a few emergency room beds open,” said Patrick Lenahen, chief medical officer at Roxborough, in an interview Tuesday. These patients “have nowhere to go. It’s very hard.”
The hospital had 62 patients Tuesday, with 15 of them stuck in the emergency room. Meanwhile, on a typical day lately, five or six patients in proper hospital beds are what Lenahen described as “ready to go and nowhere to go.”
» READ MORE: Delaware County hospitals hit capacity this week.
The situation at Roxborough, owned by Prime Healthcare Services Inc., is common around the region, as health-care providers of all types — including home care, dialysis, and nursing homes — endure severe stress during the latest COVID-19 surge. The variant behind the surge, omicron, causes less severe illness on average, but the large numbers of infections have pushed hospitalizations to record levels with no certainty of when the wave will peak.
Some area health systems declined to discuss the backlog of patients needing nursing-home care because they didn’t want to appear critical of facilities they work with closely and need to coordinate with to ensure patients don’t keep bouncing back to the hospital.
A spokesperson for Jefferson Health declined to comment. Representatives of University of Pennsylvania Health System and Temple University Health System did not answer questions sent by email Monday.
Others described a wide range of staffing woes throughout the health-care sector that are keeping many patients in limbo.
Widespread staffing woes
Most nursing homes “are experiencing the same issues as hospitals — breakthrough infections in fully vaccinated colleagues, causing absences and staffing shortages. This does impact the ability to discharge patients, and we are experiencing these challenges across the entire Trinity Health Mid-Atlantic region,” said Sharon Carney, Trinity’s chief clinical officer.
Trinity owns Mercy Fitzgerald Hospital in Darby, Nazareth Hospital in Northeast Philadelphia, St. Mary Medical Center in Langhorne, and St. Francis Hospital in Wilmington.
Jonathan Stallkamp, chief medical officer at Main Line Health, said his organization is facing the same challenges. “Nursing homes also have more regulations on separations of COVID-positive patients, limiting bed availability,” he said. Main Line’s four acute-care hospitals are Bryn Mawr, Lankenau, Paoli, and Riddle.
The Pennsylvania Health Care Association, a Harrisburg trade group for nursing homes and other long-term care providers, this week issued a set of proposals for increasing staffing levels in nursing homes to relieve pressure on hospitals. One step would be to identify regions with the greatest need for nursing-home access, and then to see if any nursing homes have beds not being used because of staffing shortfalls. The group would like the state to use the Pennsylvania National Guard and federal resources to boost staffing in those facilities.
» READ MORE: Omicron surge hitting hospital staffs hard.
Staffing problems have even affected some insurers, said Ronak Bhimani, chief medical officer at Lower Bucks Hospital in Bristol Township. ”They don’t have staff, so they are unable to give us authorizations in a timely fashion. The whole thing is kind of backlogged, causing a lot of chaos.”
Patients with nowhere to go
In Philadelphia, homeless patients with nowhere to go, both with COVID-19 and without, are part of the mix that is pressuring hospital capacity, hospital officials said.
“People who are homeless do go into ERs, or may already be patients of the hospitals — they may be [COVID] positive, but not symptomatic. The hospitals are trying to help get people into quarantine and isolation, and keep beds free for people who are truly sick,” Liz Hersh, director of the city’s Office of Homeless Services, said Wednesday.
The city’s quarantine and isolation site in Center City is full with 131 residents, Hersh said. It is for people who test positive for COVID and are experiencing mild or no symptoms — and who live in shelters where they can’t isolate.
Michael Hinson, the president and chief operating officer of SELF Inc., the largest emergency-housing organization in the city, said Philadelphia needs more staff and more capacity at its quarantine sites so they can take in residents after hours. Shelters also should be given more staff or more training so they can care for quarantining residents, he said. The layouts of many shelters, he said, make it almost impossible to truly isolate positive residents.
Hospitals, he suggested, could help fund quarantine locations as well. “We don’t want to overburden them with people who aren’t sick,” he said. “Perhaps they could use some of their resources to temporarily fund a location so that people who don’t need to be in ERs can still convalesce and get the help they need.”
This week all six Delaware County hospitals were also at capacity, officials said, and Crozer Health said it would temporarily close the emergency department at Springfield Hospital to spare staff for other hospitals in its network.
Lenahen, the chief medical officer at Roxborough, called the situation particularly troublesome for long-term dialysis patients whose usual dialysis center won’t take them back if they contract COVID-19.
“We have to find another center that may have an open chair for a COVID patient, something that is very limited in number throughout the Delaware Valley,” Lenahen said. “We have patients that have to go from Roxborough to Harbison Avenue or way out in Delaware County to get dialysis once we find that chair, and that could be a week or so, waiting to find a chair.”