Why Has the Hospital Turned into Long-Term Care?

by Tiffany Ferguson, LMSW, CMAC, ACM
Published on Oct 26, 2022

This article first appeared on RACmonitor.com on October 26, 2022

Theoretically, we know that patients needing custodial care are not supposed to be in the hospital without medical necessity, but in many cases, they show up in the emergency room and are admitted into the hospital because there is nowhere else for them to go.

The emergency-room physician believes that they can’t safely discharge the patient from the ED; however, they have no idea that once that patient, often a senior, goes upstairs to the hospital floor, the problem continues. Have we solved the problem, or have we just moved the problem from the ED to the hospital unit?

What happens next is often that the patient becomes a permanent resident of the hospital while the case management team attempts to mission-impossible a plan that will try to figure out supports, financials, long-term benefits, and all the logistics of getting this type of patient into permanent supportive housing. For every hospital our team visits, and in discussions with various healthcare leaders on this topic, the story is consistent, and unfortunately, not unique.

Often, the ability to move such a patient back into an appropriate setting is dependent on the social services in the local jurisdiction and the state governmental policies that exist for long-term benefits and permanent supportive housing. There are so many social complexities with these cases, many of which have nothing to do with the hospital setting. These patients can be in the hospital for months to years…yes, years…I have seen it!

According to the American Health Care Association and the National Association of Assisted Living, more than 325 nursing homes have closed since the pandemic, with another 400 expected to close by the end of 2022, based on current financial trends. And although I see plenty of assisted living homes popping up, many places that are closing are smaller facilities, meaning fewer than 100 beds, with at least 60 percent of their occupancy being Medicaid-dependent.

Based on the previous closures, most of these facilities had 4–5-star ratings on Medicare.gov. Additionally, it is reported that if the Public Health Emergency (PHE) ends, which would mean reductions to Medicare and Medicaid, an additional 32-38 percent of nursing homes would be at risk of closure. The total estimate is 417,000 seniors who would be at risk of losing their housing.   

Alternative options are also limited, as low staffing levels continue to impact home care services in the home health and private duty sectors. The hospital is clearly not the best place to be, but where else are these patients supposed to go? I will continue to research this topic, and would love to hear from health systems and organizations that have come up with innovative approaches to solve this problem, to share on future broadcasts. Please feel free to email me at tferguson@phoenixmed.net.   

Today I ask, are your health systems having difficulty with social admissions because of a lack of permanent supportive housing? The responses from the Monitor Mondays Listeners Survey may surprise you; they can be viewed here.

Programming Note: Listen to Tiffany Ferguson’s live reporting on the SDoH every Monday on Monitor Mondays at 10 a.m. EST.