Updated at 1:27 p.m. Feb. 17
Staffing shortages and the closing of nursing homes across the state have led to a system-wide health care crisis for patients awaiting discharge to long-term care, according to the latest report released by the Massachusetts Health and Hospital Association. It’s a problem that experts say especially impacts those with less access to services, creating an issue of health equity.
The MHA Throughput Survey Report released last month shows 891 patients in hospitals statewide are waiting to be transferred to services like skilled nursing homes, long-term acute care hospitals and inpatient rehabilitation facilities. Hospitals reported that the top challenges of getting patients into long-term care include issues with insurance, lack of a health care proxy and staffing constraints.
Adam Delmolino, director of Virtual Care and Clinical Affairs at the MHA, said a severe shortage of health care workers is among a myriad of issues creating the delays.
“Our entire system remains in crisis. And this is a big factor in the crisis,” he said.
Delmolino said nearly one in four jobs at Massachusetts nursing facilities are vacant, and expects that the staffing problems won’t let up until 2027.
Nearly a third of patients who are ready to enter long-term care have been waiting in hospitals for more than a month, according to the report. Since the MHA first started tracking the flow of patients through hospitals in May 2022, the organization has found that hundreds or even more than a thousand patients are waiting in hospitals at any given time.
Twenty-five Massachusetts nursing facilities have also closed since the start of the pandemic — with many closing since mid-2022, according to the Massachusetts Senior Care Association.
Tara Gregorio, the association’s president, attributes the closings to the staffing crisis that has left many facilities unable to fully staff available beds.
“Despite the nursing facility sector’s best efforts to retain and hire staff by significantly raising wages over the last three years, we simply are unable to compete in an extremely competitive labor market,” she said. “While the state and federal government have made significant investments in nursing care facility care during COVID, more is needed, as a number of facilities remain at imminent risk for closure.”
Christine Schuster, president and CEO of Emerson Health and Board Chair of MHA, said the clogs in the system are caused by everything from staff shortages, insurance issues, health proxy and guardianship problems, to lack of transportation. All of this leads to hospitals’ inability to move patients from crowded emergency rooms to the next level of care.
Schuster said the issue exists with behavioral health patients, too, and it creates a trickle-down effect. Weekly reports from the MHA have found hundreds of people across dozens of Massachusetts hospitals waiting in emergency rooms for behavioral health beds.
“You end up providing in-patient medical, surgical, intensive care in the emergency department setting, which is not where you want to be delivering the care the patient needs,” she said. “You don’t want a behavioral health patient to be in an emergency department bay waiting for a bed when they really should be in a locked unit.”
One hospital official said the issues with getting patients out of hospitals and into the facilities they need are less severe for those with good insurance, a good social support system and those of a higher economic background.
Rebecca Sweeney is associate chief of care management at Cambridge Health Alliance, which runs Everett Hospital and Cambridge Hospital. Sweeney said, as a safety net hospital group that treats a large population of patients with mental health and addiction issues, they face a unique challenge transitioning patients to the next services, known as post-acute care facilities.
“It’s a huge health equity issue,” Sweeney said. “If you are poor, if you have a mental health issue, if you have an addiction, if you are housing insecure, if you have no family, no social supports, you are going to have a really hard time accessing post-acute care.”
Sweeney said the issue of finding placement cuts across racial and ethnic lines.
“It’s more like poverty or lack of social support is really where it’s cutting,” she said.
The MHA is an advocacy organization with 70 licensed member hospitals that serves as the voice on legislative issues and seeks to advance higher-quality, cost-effective and accessible health care.
Industry leaders appear to have reached a consensus that it’s urgent to solve the problem as the commonwealth’s population ages and as seniors live longer and need acute care.
“We must develop the workforce pipeline for across all these positions, including registered nursing positions in skilled nursing facilities and in-home care. And that requires money,” Delmolino said. “It requires support and reimbursement for these facilities so that they can build programs for specialized care beds.”
Correction: An earlier version of this story misnamed Emerson Health and Everett Hospital.
