Home Care Shortage Keeps Patients in Strained Hospitals

Hospitals stretched by an influx of patients due largely to the Omicron surge are also facing the challenge of moving those patients out.

Staffing shortages at home health agencies may be keeping patients in the hospital longer than they need to be there, doctors and other sources said.

“Everybody is reporting that they are turning away patients because they don’t have adequate staff,” Bill Dombi, president of the National Association for Home Care & Hospice, told MedPage Today.

Dombi didn’t have data to share, but he said the problem is pervasive across the home care industry, and is forcing physicians to get “creative” with discharge plans.

“That puts an added level of responsibility on [hospital] staff, who are already double shifting,” Dombi added.

“It’s one of those terrible circumstances where there are worker shortages in hospitals, so they may be limiting admissions. Nursing homes have limited admissions for the same reasons as home care. So it’s kind of like musical chairs,” he said.

“If you’re in a hospital, and you’re not able to get into a post-hospital care setting, then you’re probably going to stay in the hospital,” he explained. “If you’re in a nursing home and you can’t get home care, then you’ll stay there. If you’re discharged home, then you’re scrambling to put together supports for yourself, like family members or volunteers from church groups.”

Alexandra Fitz Blais, chief of external and strategic affairs for the Home Care Association of New York State, said “worst-case scenarios are all realities at this point,” as New York has been struggling through its Omicron surge.

“Hospitals are at max capacity and perhaps have to discharge patients before they’re ready to be discharged,” Fitz Blais noted. “Nursing homes don’t have capacity for these patients. What happens to them? They may wind up back in the hospital, or have some other negative health outcome.”

Sharon McLennon-Wier, PhD, executive director of the Center for Independence of the Disabled in New York (CIDNY), said her group has received “a lot of complaints from consumers” during this current surge, “especially those with severe disability who are 100% dependent on home health aides.”

One person called CIDNY for help after being left three times without an aide during the holidays — once for an entire 12-hour shift.

“This is someone who is paralyzed and unable to do activities of daily living independently,” McLennon-Wier said. “He couldn’t drink or eat for 12 hours. He wasn’t given his medication. All we could do was advise him to call 911 if he needed something to eat and drink.”

Dombi said home care agencies have reported a range of staffing shortages from 5% to 20% during the current surge. Staff are becoming ill with the disease, or they’re having to quarantine due to exposures, and there’s limited testing to help get them out of quarantine. Low vaccination rates among this population have also been an issue, he noted, and vaccine mandates have raised concerns that more workers may be out.

Still, home health aides were in short supply long before the most recent surge, Dombi and others pointed out.

“There was a workforce shortage before the pandemic,” Fitz Blais said. “It’s only been exacerbated by the onset of the pandemic, and then more recently with the vaccine mandate and other issues along those lines.”

A recent informal survey of Home Care Association of New York State’s membership revealed that, as with nursing, COVID has led to fewer people joining the field overall. But there’s also a need for higher wages, as well as better benefits including healthcare, child care, and transportation, she added.

“We’re all going to need someone to take care of us at some point in our lives,” McLennon-Wier said. “This has to be a respected profession where individuals are paid a living wage and receive appropriate benefits like healthcare and sick time coverage.”

In addition, the pervasive problem of low reimbursement by government and private payers for the entire field needs to be resolved. This prevents agencies from providing pay and benefits competitive with other settings, resulting in a loss of staff to those settings, Fitz Blais said.

Dombi noted that his organization was supposed to have a conference during the third week of February, but it’s been cancelled because many of the administrators who were set to attend are needed to help with patient care.

“They’re trying to fill every shift of care that they can,” Dombi explained.

Joel Zivot, MD, an ICU physician at Emory University in Atlanta, pointed out that long-term care facilities are also full, adding to the strain on hospitals.

“If a person has no place to go when ready for discharge, the whole system grinds to a halt,” Zivot said. “Good aftercare is as essential as ICU care.”