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Patients with nowhere else to go are filling up Vermont hospitals amid nursing home shortages

Hospital Bed
Vermont hospitals are filling up with long-term patients due to a lack of placement options, like residential care facilities. In some cases, it's delaying other patients' access to needed care. The problem has only worsened since the COVID-19 pandemic.

Health care officials told lawmakers Wednesday that a shortage of nursing home beds has forced hospitals to become residential care providers for patients who have nowhere else to go.

Dr. Stephen Leffler, the chief operating officer at University of Vermont Medical Center, said his hospital is currently boarding 68 patients who are ready for discharge. Lack of placement options for those patients, he said, is delaying access to care for people with serious medical needs.

“A long-term boarder on one of our medical floors may not seem like a big deal, we have 430 beds,” Leffler said. “But if every bed is full, where is that patient going to go?”

Leffler told lawmakers that patients can end up living at the hospital for months, and in some cases, more than a year. And he said UVM Medical Center’s inability to discharge patients to appropriate residential or home care settings has worsened since the beginning of the COVID-19 pandemic.

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“I would argue that it wasn’t perfect prior to the pandemic,” he said. “But it’s made it infinitely more difficult to discharge patients.”

Though UVM Medical Center incurred more than $3 million in unreimbursed care due to “boarders” in the first quarter of the fiscal year, Leffler said he’s asking lawmakers to direct any increased funding to skilled nursing and other residential and home care programs that have seen capacity shrink in recent years.

“Make investments so we have more nursing home capacity, more beds for patients with high acute needs, and opportunity for people to get care in their home when they need it,” he said.

Suzanne Anair, a nursing home administrator in Bennington, said a combination of financial pressures and workforce shortages have constrained capacity at her facility, called the Centers for Living and Rehabilitation in Bennington.

“We have not rebounded from COVID,” Anair told lawmakers Wednesday.

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She said her organization spent nearly $5 million on temporary nurses and other contract employees in 2023 due to an inability to fill vacancies. And she said those costs have exacerbated financial pressure at a facility where 90% of residents are on either Medicaid or Medicare.

Provider reimbursement rates from government insurance programs, she said, often fall short of the cost of delivering care.

“The concern we have in the industry … is that facilities are choosing not to fill beds,” Anair said. “They’re still licensed. They’re still paying taxes on them. They cannot staff them.”

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Sara King, president of the VNA & Hospice of the Southwest Region, said visiting nurse agencies are managing a similar dynamic.

King told lawmakers her agency ran a $2.3 million deficit last year in part because 92% of all their revenue comes from Medicaid and Medicare.

“Medicare is constantly cutting us and has been cutting us and will continue to make cuts to us. But we need to remain competitive with our salaries … if we can’t remain competitive, they’re not going to come to home care,” she said. “We’re all losing money. All of us home health agencies in the state are losing money. And it’s really not sustainable.”

Lawmakers say they’re considering increases to Medicaid reimbursement rates for residential and home care providers in this year’s budget.

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The Vermont Statehouse is often called the people’s house. I am your eyes and ears there. I keep a close eye on how legislation could affect your life; I also regularly speak to the people who write that legislation.
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