This commentary is by Christine Werneke, MS, president and chief operating officer of UVM Health Network – Home Health & Hospice in Colchester, and by Stephen Leffler, MD, president and chief operating officer of the UVM Medical Center in Burlington.
Every day, too many Vermonters are suffering because they cannot get access to the right level of care they need after a hospitalization, after they’ve gotten too sick to be safely cared for at home, or because they’re waiting for a hospital bed that is not yet available.
This is because Vermont has a severe lack of capacity for patients who need long-term care outside of the hospital. The situation has become chronic and is causing constant overcrowding in our hospitals across the state, straining our health care staff and negatively impacting our patients and all of the communities we serve across our region. As we write this today, 65 patients at the University of Vermont Medical Center are ready to leave and head to their next level of care, such as a nursing home or rehabilitation center. Some will wait days, weeks, months — or, shockingly, more than an entire year — for the right care setting with the right supports. In January, we saw a record high of 83 such patients waiting, representing more than a quarter of the beds in our hospital that we use for adult patients receiving medical treatment or recovering from surgery.
As the region’s Level 1 Trauma Center and academic medical center, the UVM Medical Center must be ready to care for our most acutely ill friends, family and neighbors from across our region. When dozens of patients are waiting for a place to go, it has a devastating ripple effect. Patients arriving to the Emergency Department who require an inpatient room wait longer to be admitted. The ED becomes overcrowded and patients receive care in hallways. Several of our Emergency Department colleagues recently shared their frustration and anger in an opinion piece on this pattern, which is repeating itself all over Vermont and northern New York. The nursing home crisis impacts all other patients who need timely access to care. When hospitals are unable to appropriately transfer a patient to a nursing home bed, that hospital bed isn’t available for a patient with an acute health care need.
One way to come at this problem is to better support families caring for a loved one at home, by expanding and better funding home health care and pursuing initiatives like the UVM Health Network’s Dementia Family Caregivers Center. For many patients — especially those with conditions like dementia –— the most appropriate place to receive care is in their own home. But families need help to be successful. UVM Health Network — Home Health & Hospice, and local home health and hospice agencies serving our neighbors statewide, excel at providing exceptional care in the home to both patients and their families, but only when they have the resources to hire talented caregivers.
Then, when families decide that their loved one’s care needs exceed what can be provided at home, they should not have to wait for a nursing home bed while their family member languishes. Vermonters deserve a system where patients receive the right care, in the right place, at the right time. This requires additional investments from Medicaid to broaden our skilled care in the home and bolster capacity in our nursing homes. At the federal level, Congress must not cut Medicare rates for home health services and should reverse course on burdensome staffing mandates for post-acute providers.
The need for action is also urgent because this crisis is continuing to drive up the cost of care. It is more expensive for patients to stay in the hospital than it is for them to receive care at a nursing home or in their own home. And eventually, hospitals stop getting paid when someone stays longer than they should.
Vermont’s population is aging, and this challenge is only going to grow. To be clear, the impacts will be felt most by those who have the least and live in our most rural communities. Thankfully, it is solvable. Recent efforts, like state contracts with iCare Health Network to provide additional nursing home beds for patients with complex care needs and the Governor’s recommendation to increase reimbursement rates for nursing homes, are a good start. But with an estimated 500 fewer nursing home beds in our state than before the Covid-19 pandemic, we need a strategy to bring beds back online and ensure patients with non-hospital-level needs can access them.
By collaborating and investing in solutions like expanding nursing home care, increasing funding for home health services, and implementing policies that promote the long-term sustainability of our health care infrastructure, we can ensure that our friends, family members and neighbors can live their best lives here in Vermont without fear of not receiving the care and support they need from their trusted health care system.
