By Christina Giardinelli, KATU
November 16, 2023
Updated: January 3, 2024
Source: KTVL
Photo / Image Source: Unsplash,
Task force meets to find solutions to hospital discharge issues in Oregon
SALEM, Ore. — A task force charged with finding solutions to help hospitals safely discharge patients is getting ready to make some recommendations to lawmakers. The group is looking for ways to make sure patients who are not able to care for themselves or who are homeless get the care they need after being discharged.
Since the pandemic, hospitals have been telling lawmakers that because of gaps in the state's long-term care network, patients are boarding longer than medically necessary, occupying bed space, weighing on hospital capacity as well as their bottom line.
"There are so many stakeholders, so many parts in this system, and they weren't really communicating with each other at all in certain cases, and a lot of us are laboring under systems and rules and regulations that were established 20 years ago," said Jimmy Jones, task force chair and executive director of the Mid-Willamette Valley Community Action Agency (MWVCAA).
Since then the needs of patients have changed as has the severity of their condition.
Jane-ellen Weidanz, Deputy Director for the Oregon Department of Human Services, during the task force's first meeting, explained that amid the pandemic a hospital discharge workgroup found that many of the skilled nursing facilities and adult foster homes were rejecting patients, even if they had open beds, because of dual diagnoses.
"Facilities call them inappropriate referrals. Hospitals say we want them out, so you have this discrepancy between what the long-term care system thinks they can serve and who the hospitals think are ready to go," Weidanz said. "Inappropriate referrals (during the time the workgroup looked at this).
Jones said when it comes to the homeless population, the issues become even more pronounced because unsheltered conditions make health recovery close to impossible in most instances.
"A lot of them would normally fairly easily be treated in a housed situation like diabetes, but people can't keep their medicines, which are frequently stolen. They don't have the ability to refrigerate anything. So you add all of that together, and it becomes virtually impossible for somebody to stick to a medical regime," he said. "Wound care in particular is virtually impossible in an unsheltered living situation, so a lot of times we see infections as a result of that that lead to just disastrous health outcomes that could have easily been corrected.”
Despite those exacerbating factors, Jones said most individuals who are homeless are able to stay stable after being discharged at least until they can find help through a shelter provider, but in some cases when they are discharged at night in the cold, the consequences are deadly.
"About 10% of the homeless population are living with such extraordinary medical conditions that [are] complicated by substance issues and complicated by mental health, they are in danger every time they are exiting from a hospital setting," Jones said. "I have seen over the course of my career people who were discharged safely at 8 o'clock at night die of hypothermia by 8 o'clock the next morning."
While hospitals usually attempt to make a warm hand off to a service provider in many instances, if discharge occurs at night the service provider is closed. The hospital sometimes sends the patient to a warming shelter by cab but oftentimes the person is not able to be in a congregate setting and/or will choose to be dropped off elsewhere. Hospitals are also not able to stop the patient from leaving of their own accord.
Jones said one of the things the task force is working on is building up the lines of communication between the various types of providers so that social service providers are aware of instances like those and are able to intervene.
MWVCAA does operates a 24/7 Shelter Care Plus program for individuals recovering from health care issues.
"There is a referral process to get in it. We don't really take walkups there, but if the hospitals and the federally qualified health centers," Jones said. "We are not perfect either in the sense that we can't just take everybody that they might refer to us because we are not a medical provider at all. The folks that they refer to us have to be able to do their daily activities of living."
Hospitals in many parts of Oregon do not have a list of providers like Salem's Shelter Care Plus Program that they can call for discharge 24/7.
Jones said the homeless population is at greater risk for illnesses and comorbidities, which means they are more likely to keep ending up in the hospital.
"Living outside for long periods of time in wet and cold conditions with untreated chronic health conditions is very destructive on somebody's physical health, and we see people who are 45 or 50 years of age, but in every sense of the word they are really closer to 70 most of the time," he said.
The task force is set to finalize a progress report to the Legislature before the 2024 legislative session, but Jones said policy recommendations at this point will be minimal.
"Quite frankly, we haven't had time to have all of the conversations that we need to have and engage the state agencies, DHS, OHA, and other systems that we are going to need to have conversations with to provide any sort of big recommendations," he said.
The task force had its third public meeting on Nov 11. It will meet again Dec 12. Public comments are accepted.
Jones said smaller "low-hanging fruit" recommendations may be proposed this session, such as ways to make sure that long-term care providers are able to be compensated more quickly through Medicaid.
"They are really waiting a long, long time to determine Medicaid eligibility for certain clients, and they are incurring financial risk around that as well," he said.
He said there may also be some policy work done to reform the state's Public Guardianship Program to remove some barrier for people to assume guardianship of individuals who are unable to care for themselves.
Note: A previous version of this article misattributed a quote to Danielle Ross. The quote should have been attributed to Jane-ellen Weidanz. The article has been corrected.
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