Oregon’s hospital system is facing a major bottleneck, with emergency rooms clogged by patients awaiting a transfer to appropriate care settings. A newly released report from a state task force offers potential solutions to ease this burden and ensure more timely care.
The state’s healthcare system has long struggled with patients occupying hospital beds despite no longer needing acute care. Many are stuck in emergency rooms for days, waiting to be moved into long-term care, shelters, or other appropriate facilities. The issue is especially dire for vulnerable groups, including homeless individuals and low-income residents, who often face life-threatening delays in the care they need.
This persistent problem has sparked a year-long effort by a task force of 21 members who have now proposed a set of actionable recommendations to ease the hospital discharge process. These suggestions, outlined in an 83-page report, focus on improving the flow of patients through Oregon’s hospital system, especially for those with complex health needs who require long-term care options.
The Impact of Boarding: An Overburdened System
Oregon’s hospital network, which includes nearly 60 acute-care hospitals, has seen a rising trend in “boarding” – a term used when patients stay in emergency departments for extended periods because no beds are available. These patients no longer need the level of care that hospitals provide, but they still require assistance, whether it’s waiting for Medicaid approval or finding a suitable group home or long-term care facility.
This practice is not only harmful to the patients but also impacts the hospital system as a whole. It strains resources and delays care for other individuals seeking emergency treatment. In 2023, Providence Health & Services, Oregon’s largest hospital provider, reported that its facilities alone faced more than 5,700 extra bed-days every month. That’s equivalent to admitting and holding 37 patients every day for an additional five days.
For healthcare professionals like Dr. Ray Moreno, the chief medical officer at Providence St. Vincent Medical Center, these numbers are staggering. “It’s like building another hospital just to deal with these patients,” he said.
Proposed Solutions: Addressing the Root Causes
The task force’s report emphasizes multiple strategies to alleviate this crisis. One of the main recommendations involves speeding up the Medicaid approval process for individuals who require long-term care. Currently, many patients waiting for approval are stuck in the hospital system, unable to move to facilities that can meet their needs.
There is also a clear need to expand the availability of long-term care options. Oregon’s system is under pressure due to the lack of residential care facilities, particularly those designed for individuals with behavioral health needs. The report highlights the importance of increasing the number of adult foster homes, which provide care for small groups of individuals with various needs.
Another key focus is improving support for Oregon’s Public Guardian program. For individuals who need assistance in making decisions about their healthcare – such as homeless individuals or those with complex medical histories – having a legal guardian can be essential. The task force is recommending additional funding for this program, which would include grants for legal services and training for family members and friends who wish to serve as guardians.
Some specific legislative proposals outlined in the report include directing the Oregon Health Authority and the Oregon Department of Human Services to review and revise regulations related to the flow of patients in long-term care settings. These changes would aim to streamline the process and reduce the bottleneck currently plaguing the system.
Funding Challenges and the Path Forward
While the task force’s recommendations provide a clear roadmap to addressing the hospital boarding crisis, the success of these measures ultimately hinges on funding. Lawmakers will need to allocate sufficient resources to implement these changes, including increasing reimbursement rates for adult foster homes and expanding Medicaid coverage.
Senator Deb Patterson, D-Salem, who chairs the Senate Health Care Committee, expressed support for the task force’s recommendations, emphasizing that the goal is to ensure that patients receive the right care at the right time. “This is about making sure people are in the proper setting, and that they don’t remain stuck in a system that doesn’t meet their needs,” she said.
However, funding remains an open question. As the legislature looks to address these recommendations, the task force’s report underscores that solving the problem requires a multifaceted approach, involving cooperation across healthcare providers, state agencies, and local governments.
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