This article by Nora Doyle-Burr was published in by the Valley News on Aug. 29.
After an infection in his heel required that Bill Blodgett have his leg amputated last December, he couldn’t go back to where he was living in Hartland because it wouldn’t accommodate a wheelchair.
Having one leg also meant the 61-year-old who’s cooked in restaurants “all over the Upper Valley” couldn’t find a place in an assisted living facility despite sending out about 40 applications, he said in a Thursday phone interview from his room at Mt. Ascutney Hospital and Health Center in Windsor, where he’s now been living for 8½ months.
“If it wasn’t for the nurses here, I’d have lost it a long time ago,” Blodgett said.
Before the Covid-19 pandemic, Mt. Ascutney sometimes had trouble moving patients like Blodgett on to other settings once they were no longer in need of hospital-level care. But that problem has worsened in recent months so that six to eight of the Windsor hospital’s 25 beds now are regularly taken up by people who don’t need to be there, according to Mt. Ascutney CFO David Sanville.
As a result, Sanville estimates the hospital has lost $700,000 providing that care because Medicaid only covers a portion of the hospital’s cost related to such patients.
“We lose money every day they’re here, even when (we’re) getting paid by Medicaid,” he told the Green Mountain Care Board at a budget hearing earlier this month.
This also means that patients aren’t getting the support that they would in another setting such as a nursing home, memory care unit of an assisted living facility or through care at home.
A hospital is “not an ideal place for somebody to live,” Sanville said in a phone interview last week.
Blodgett now has a plan to move in with a family in Springfield, through an organization called Vermont Comforts of Home, which places adults in need of nursing home-level care in homes around the state. The organization, which has Upper Valley offices in Springfield and Bradford, follows the regulations of Vermont’s Choices for Care initiative, which allows people who qualify for Medicaid to receive long-term care in a setting of their choice.
But that plan, too, has run into delays as the family works to update their house to make it more accessible and comply with the state’s regulations.
“Anything through the government takes a lot of red tape and stuff,” Blodgett said.
Wilder resident Andy Leckart and his wife, Sue, are also familiar with the limitations of long hospital stays.
Sue Leckart, who has Alzheimer’s disease, was admitted to Dartmouth-Hitchcock Medical Center in early June. She became agitated to a degree that Leckart said he could no longer manage on his own. She remained at DHMC for 11 weeks until last Wednesday, when she moved to a nursing home in Granville, New York, an hour and 45 minutes away.
“There’s no place for these people to go,” said Andy Leckart.
The nursing homes with memory care units that are accepting new residents require negative Covid-19 tests before entry, as well as a 14-day quarantine upon arrival, he said. They are only taking one new resident at a time.
While the distance to Granville is great, Leckart said that, during the pandemic, it would be difficult to visit and that he hopes to move Sue closer to home when a bed becomes available. Most importantly, he said, he expects the nursing home will be a “much better thing for her.”
Though Leckart was complimentary of the care Sue Leckart received at DHMC, he said she was on medications to manage her anxiety that made her drowsy. After her quarantine at the nursing home, Leckart said, Sue will be able to interact with other residents and move around more than she has at the hospital, where she was confined to her room.
“I expect when she’s in a different situation in the memory care unit, they’ll probably be able to play around with those levels of medication,” he said.
Acting DHMC Chief Medical Officer Jonathan Huntington said in an email that the problem of boarding there hasn’t worsened significantly during the pandemic, but “some delays have occurred while we wait for testing.”
DHMC faces “normal challenges” in finding patients appropriate care when they’re ready for discharge, he said.
The reasons for the logjam at Mt. Ascutney are myriad, according to Sanville. It’s “impossible for me to just point at one thing,” he said.
Early on in the pandemic, nursing homes, assisted living facilities and other congregate living places stopped accepting new residents in order to avoid bringing in someone new who might be carrying the virus, Sanville said. In addition, he noted that facilities have struggled to obtain the necessary personal protective equipment to keep staff and residents safe, such as masks, face shields and gowns.
The processes of completing paperwork to get patients on to their next spot also have been slowed by the fact that most office workers have been working from home during the pandemic, Sanville said.
Patients who under normal circumstances might be able to go home with some support from home health aides have had trouble returning home, either because family members aren’t able to take on the tasks associated with their care or because home health agencies have been stretched thin, Sanville said. For patients who could go to live with family members in other states, that process has been complicated by complying with multiple states’ Covid-19-era rules, he said.
“Everybody’s super-cautious, doing the most right thing,” Sanville said. “Unfortunately, it’s really not helpful. Some of these folks aren’t able to get places.”
Blodgett is hopeful that he will finally be able to move into the Springfield home in the next few weeks once the renovations are complete and state regulators give them the thumbs-up.
Among the things he’s most looking forward to are cooking and eating something other than hospital-provided fare such as cube steak, he said.
“Things are coming together,” he said. “It was really bad when I didn’t know about anything, when nothing was happening, like slipping gears. It’s slowly coming together. (There’s) light at the end of the tunnel now where before there wasn’t.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
