Already crowded hospitals across Massachusetts are being forced to keep patients on their wards for weeks after they would otherwise be discharged for rehabilitation or long-term care because there are so few available spaces at nursing homes struggling to stay open amid the Omicron surge.
At Brigham and Women’s Hospital, more than 200 patients sat in limbo Monday. The sickest had waited an average of about three weeks, because so many nursing homes have been forced to close their doors to new patients.
Nursing home industry leaders say they are verging on a crisis. Acutely short-staffed even before the surge, they are facing growing numbers of workers sidelined by infections, spot shortages of rapid test kits, and a state rule many say is outdated that forces them to intermittently freeze admissions. As a result, hospitals across the state, slammed with record numbers of severely ill patients sick with COVID and other conditions, are facing critical bottlenecks at a time when their capacity is at peak levels.
“I am not sure what’s going to happen within health care as a whole to get over this hump,” said Kevin Morris, president of BaneCare, a company with 11 nursing homes in Massachusetts.
Nursing home leaders are pleading for more help, requesting additional state-sponsored Rapid Response teams of health care workers, as well as assistance from the Massachusetts National Guard, which helped homes with testing early in the pandemic.
“When we needed them . . . they were a godsend,” said Morris.
He said nine of the company’s homes have been intermittently restricting admissions because of staffing shortages.
“And the two left that are out there taking all admissions now, I am not sure they will be doing that much longer,” he said.
Nursing homes in Massachusetts and across the country were overwhelmed with infections and resident deaths early in the pandemic, prompting the Baker administration in November 2020 to direct nursing homes to stop accepting new admissions if they have a total of 10 or more infections among staff and residents.
Nursing home leaders say that rule is outdated and is exacerbating the health care bottlenecks because most COVID infections today among vaccinated staff are mild, allowing workers to return more quickly. Easing the state rule would translate to fewer and, more likely, intermittent admission freezes, nursing home administrators say.
“It’s not one size fits all. The rule shouldn’t be a magic number of 10,” said Dr. Asif Merchant, partner of a company that runs medical services for 45 nursing homes in Massachusetts. If the homes have the right staffing and the ability to isolate infected patients, it shouldn’t be an issue, he said.
State data show just nine nursing homes were ordered to freeze admissions in the past month after exceeding the case limit. But over 60 percent of homes reported closing admissions intermittently because of staffing shortages, according to Massachusetts Senior Care Association, a trade group.
More than 40 percent of the state’s roughly 370 nursing homes reported staff infections Monday and 15 percent reported resident infections, state data show.
Last month, the Baker administration deployed 300 National Guard members to help 55 overwhelmed hospitals and 12 ambulance service providers. Mass Senior Care said similar help from the Guard is sorely needed in nursing homes, too, for assistance in nonclinical roles including laundry, housekeeping, meal preparation, and delivery.
A Baker administration spokeswoman said that since the beginning of the pandemic, the state has provided nursing homes with more than $700 million in resources and support, including testing kits, personal protective equipment, temporary health care workers, and money to stabilize and increase staffing. She said the state continues to increase the number of temporary agency staff under contract to support nursing homes but did not say whether the administration plans to deploy Guard troops or additional temporary workers.
The fallout from overwhelmed nursing homes is significantly affecting Mass General Brigham, the state’s largest health care system. At its two flagship hospitals, the Brigham and Massachusetts General, 20 to 30 percent of beds are occupied by patients simply awaiting discharge to a setting where they can regain their strength after an acute illness, or receive more long-term care, such as a nursing home or rehabilitation facility.
“Patients with the most complex needs for post-acute care are waiting an average of up to to 24 days” at the Brigham, said Dr. Ron Walls, Mass General Brigham’s chief operating officer.
The length of the wait is up 200 percent over just the past two months, he said.
At Tufts Medical Center, it’s not uncommon to have 20 to 30 patients a day who could be discharged if nursing homes could take them or more home health care services were available, said Terry Hudson-Jinks, Tufts’ chief nursing officer and chief patient experience officer.
“It’s one more thing on top of another in a system that has already been challenged for two years now,” she said.
Transitioning patients from hospitals to post-acute-care settings has been “an incredibly complex undertaking throughout the course of the pandemic,” Patricia Noga, vice president for clinical affairs at the Massachusetts Health & Hospital Association, said in a statement.
She said leaders from hospitals, nursing homes, and other care providers continue to meet with state officials to problem-solve and “share honest feedback” about how to alleviate the bottlenecks.
Complicating the issue is a rising number of resident COVID cases traced to visitors who are walking infections through the front doors at many Massachusetts nursing homes, industry leaders say. Federal rules urge nursing homes to encourage visitors to get vaccinated and tested before entering, but prohibits them from requiring it as a condition of entry.
“We have a lot of people refusing [rapid] tests, they’re just refusing it, and I can’t make heads or tails of that,” said Morris, president of BaneCare.
The Centers for Medicare & Medicaid Services, which issued the federal rules, said in a statement the agency “will continue to monitor the available data on COVID-19, especially the Omicron variant, within facilities, and take additional steps as needed to protect the safety of residents,” but declined to say whether it would require testing or vaccination for nursing home visitors.
That leaves nursing home leaders urging visitors to do their part with testing and shots, as they plead with the state for reinforcements.
Recent state assistance from National Guard troops has been a lifeline for stressed hospitals, said Terry Hudson-Jinks, Tufts’ chief nursing officer.
She said the Guard is helping with crowd control at the hospital’s busy walk-in testing and vaccination site, as well as transporting patients through the emergency department and to other parts of the medical center, freeing up medical staff.
“It can feel very lonely, and to have the state step up and send in reinforcements is a huge help,” Hudson-Jinks said. “It all matters.”