Our healthcare system is under strain. This isn’t new news, but the ongoing impact on patient care is significant. As hospitals reach capacity, post-acute inpatient care options face similar challenges.
But have we explored enough to ensure that home-based care is a viable and cost-effective option?
Before the COVID-19 pandemic, our hospitals, clinics, and other healthcare facilities faced many challenges that affected their ability to provide the right level of care to patients when and where they needed it. Even today, post-pandemic, these issues remain at the forefront.
One of the primary causes of New Hampshire’s health care crisis is the inability of hospitals to discharge patients to safe and appropriate post-acute care facilities (such as nursing homes or assisted living facilities). In many cases, that means simply going home. Hospital discharges are a key metric for judging the success of our health care system, and for hospitals, it also means they have beds available to treat more patients.
The reasons for delayed discharges are many and complex, outlined in a June report from the New Hampshire Hospital Association. Among the “barriers to discharge” cited in the NHHA report, insurance is the biggest impediment to discharge. Long wait times for Medicaid determinations, insurers not covering post-acute care, denial of approval requests from insurers, or inadequate post-acute care networks are some of the reasons. Housing issues, staffing shortages in nursing homes and skilled nursing facilities, and lack of access to needed community services are also major causes of discharge delays.
And if these patients cannot be safely and appropriately discharged, where do they go? They remain in beds that are being sought by many waiting patients. In the worst cases, some of these patients remain “admitted” in hospital emergency rooms, creating even more unnecessary stress for beleaguered emergency room doctors, nurses, and staff.
According to the NHHA, in the first six months of 2024, the number of medically unwell patients waiting for discharge dropped from a peak of 130 in September 2023 to 79 in June 2024. Of these 79 patients, 15 were waiting for an inpatient bed in the emergency department. But of greater concern is the alarming number of medically unnecessary “extra days” these patients spent waiting to be discharged. Patients with nowhere else to go are taking up 7,455 days of hospital beds. One of these patients spent more than 400 days in the hospital waiting to be discharged.
Research shows that, when appropriate, home health care produces better outcomes than facilities. Home health agencies across the state are ready and willing to help with that. These agencies provide skilled nursing, physical therapy, occupational therapy, wound care and other clinical services at a low cost in the home where patients are most comfortable.
Here in New Hampshire, there is considerable work being done at the state level. In the DHHS Roadmap 2024-2025 released in June, the New Hampshire Department of Health and Human Services emphasized increasing the percentage of people receiving home-based and community-based services (HCBS) rather than nursing home care.
Programs like New Hampshire Choices for Independence provide services to seniors with disabilities and medical needs so they can return to their homes without waiting to enter a nursing home or assisted living facility.
Home health agencies help patients and caregivers address health issues before they become urgent or emergency needs requiring hospitalization and prevent readmission with health and education programs, immunization clinics, and other helpful services. The cost of these programs is a fraction of the cost of hospitalization or advanced care.
All of us in health care, from hospitals to post-acute care facilities to home and community-based health care providers, have a stake in overcoming the challenges we face here in the Granite State and across the nation. Organizations like Granite VNA can be part of the solution to this vexing and costly problem. Our goal is to provide quality health care and promote health in the home and community throughout all stages of life.
