With Oregon hospitals in crisis, state will seek ‘significant’ funds for stopgap measures
Lynne Terry/Oregon Capital Chronicle
The hospital crisis in Oregon is playing out in emergency rooms around the state.
Patients in pain wait in lobbies for hours. Some end up on gurneys in hallways while waiting for a room. After they’re treated and ready to leave, they can end up stuck in the hospital for days because rehabilitation and other treatment facilities lack beds.
“The system is slowly grinding to a halt,” said Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, a trade organization for the 62 hospitals in the state. “I think it’s safe to say it is affecting hundreds, if not thousands of people.”
She said some patients end up leaving emergency departments because waits are so long.
Although Oregon hospitals have fewer Covid patients than during infection surges, they still have too few staff members to meet the demand. Long-term care and other “step-down” services for people who are recovering face staffing shortages of their own. Even ambulance companies are having difficulty hiring people. The crisis has led to about 500 patients at any one time “boarding” in hospitals while they await a bed elsewhere.
“Those beds are needed for people sitting in emergency departments or people who are in the community waiting for their procedure to get scheduled,” Hultberg said.
Thanks to allocations from the Legislature, the Oregon Health Authority spent millions of dollars on contract staff over the last year to help hospitals get through crowding, and Gov. Kate Brown mobilized the National Guard to work in hospitals.
That help has ended. Now the hospital association wants another infusion of assistance to get through the current rough patch.
“We’re trying to take care of patients today,” Hultberg said.
In late July, Hultberg wrote to Brown that having patients stuck in hospitals prevents others from obtaining care.
“Hospitals urgently need help with this capacity crisis to free up inpatient beds and staff for patients who need to be in a hospital following a car accident, a heart attack, a cancer diagnosis or with many other needs that require hospital-level care,” Hultberg wrote.
Her letter apparently prompted talks between the hospital association and the Oregon Health Authority to determine potential short-term solutions.
“Some of the things that look more feasible right now include incentive payments for adult foster homes, state funding for contract staff in long-term care and support for the Oregon Medical Coordination Center,” Hultberg said, referring to a system of moving patients to hospitals with available beds.
State officials are considering one-time payments of $5,000 to adult care homes, which can house up to five people, for patients they take in from hospitals. The state issued similar grants to alleviate “boarding” in hospitals earlier in the pandemic.
Other money would pay for contract staff and enhancing the coordination center so it can track beds statewide and shift patients to hospitals with appropriate openings, Hultberg said.
“I don’t think one single approach is going to make a huge difference,” Hultberg said. “But several approaches together might.”
Another idea on the table would involve creating space in long-term care facilities, allowing people to be discharged from the hospital, said Liz Gharst, a spokeswoman for the Oregon Health Authority. She said those who would qualify would have to be eligible for services through the state Department of Human Services and need mental health treatment.
“Enhanced care services are intended to be temporary as individuals transition to a lower level of care,” Gharst said.
These ideas would require funds. The Health Authority is likely to ask the legislative emergency board to approve money for hospitals when it meets in September. Hultberg said the request would be “significant,” perhaps tens of millions of dollars.
No option has been nailed down, Gharst said
“There are no decisions about how much and what exactly” will be decided, Gharst said.
The lack of beds coincides with dim financial reports from Oregon hospitals.
Late last month, the hospital association said the outlook worsened in the first quarter of 2022 after a “bleak hospital financial picture from 2021.”
While operating revenues rose nearly 11% in the first quarter, expenses rose 15%, leading to half of hospitals operating at a loss, the report said.
The Oregon Health Authority said this week it was concerned about the plight of Oregon’s hospitals.
“OHA recognizes rising personnel expenses are a growing concern for Oregon’s hospitals,” said Dave Baden, the agency’s chief financial officer. “Anecdotally, we hear that temporary staffing costs made up a large portion of the increased expense.”
Hospitals have relied on short-term contract staff to fill gaps but they typically earn much more than those on staff, driving up expenses.
Hospitals have needed contract workers because they can’t find enough people to hire, Hultberg said.
“This is not hospitals understaffing,” Hultberg said. “This is a lack. We don’t have a supply of workers to meet this demand.”
Providence Health & Services, the largest hospital system in the state with eight hospitals, employs more than 23,000 workers. It has 1,700 open positions, said Gary Walker, a Providence spokesman.
He said Providence has reduced “discretionary” spending and is “accelerating collections” on overdue business accounts.
“Our biggest concerns remain caregiver and provider shortages, supply chain availability and inflation, payor partnership to support rising costs, and availability of access to services in the community for discharging patients from our hospitals,” Walker said in an email.
Oregon Health & Science University, which treats many indigent patients, said in a statement administrators have “worked diligently” to staff beds. Spokeswoman Franny White said the hospital is “maxed out.”
“We maintain overflow beds; our budget is strained; and system-wide health care workforce challenges continue,” White said in a statement.
Besides having too few staff, hospital professionals are also contending with more acute conditions caused by people postponing treatment during the pandemic.
“Sometimes those people’s conditions have worsened because their care was delayed,” Hultberg said. "So people are in the hospital longer and they’re sicker.”
Staff, care suffer
The workload is taking a toll on nurses, the largest group of health care professionals.
Matt Calzia, a registered nurse and nursing practice consultant at the Oregon Nurses Association, said overworked nurses, who’ve endured more than two years of shortages, are suffering chronic fatigue.
“It’s really having damaging effects,” Calzia said. “The care is suffering.”
He said nurses don’t feel valued, and patients have to wait longer for care.
“The nurses are faced with that moral injury. They want to serve all of the community, but they’re just stretched too thin and they’re exhausted,” Calzia said.
He knows nurses who have up to 15 years of experience who are looking to change careers. He said the situation has worsened since March when the Health Authority ended its contracts with health care staffing agencies.
“They lost that labor, and that made it worse,” Calzia said.
The state Board of Nursing also stopped issuing emergency licenses in April and the existing authorizations expired July 1, said Barbara Holtry, spokeswoman for the board. Hospitals can bring in out-of-state personnel who don’t have Oregon licenses for a limited time. Hospitals can obtain an exemption for out-of-state nurses for 90 days and certified nursing assistants can work for 120 days under certain conditions.
Nurses don’t want contract staff to be a permanent solution: It can be demoralizing working alongside people who are earning more, experts say. Also, hospitals couldn’t afford it over the long term.
The potential solutions the association and the Health Authority are considering are not long-term fixes. Hultberg said state lawmakers, hospitals and government officials need to work those out together when the bed capacity situation eases.
“We’re hopeful that things will gradually improve, that we’re hopeful that the workforce pipeline will improve,” Hultberg said. “We are hopeful that our partners in long-term care and in other parts of the care continuum can improve their staffing level. But there is no guarantee of those things.”