More state funding needed for long-term care, WSHA staffers say

Members of the Washington State Hospital Association (WSHA) plan to request funding for long-term care service providers during the upcoming legislative session.

A funding focus for WSHA continues to center on long-term care, particularly for patients ready to be discharged from hospitals and in need of post-acute care including skilled nursing facilities, adult homes, or nursing homes. WSHA Senior Vice President of Government Affairs Chelene Whiteaker said these situations can create several challenges for hospitals.

“We want the system to work and operate so hospitals can discharge people in a timely manner,” Whiteaker said. “When someone is basically living in a facility who doesn’t need to be there because we can’t find an appropriate placement, it hurts the hospital’s ability to care for other patients.”

WSHA Vice President and Associate General Counsel Zosia Stanley said several barriers delay patient placements, which lead to patients staying in hospitals longer than necessary. A common barrier is the waiting period a patient has to endure if they need a guardian to assist with decision-making.

“Traditionally, DHS could look to a decision-maker to make a decision for a patient who lacks that capacity,” Stanley said. “If you have an attorney, they make decisions. If not, they look to a spouse or family. If you can’t make your own decisions, they make decisions. If you don’t have power of attorney, your only option is a guardian.”

The COVID-19 pandemic greatly exacerbated that issue, Stanley said.

“During the pandemic we had hospitals at 120% capacity,” she said. “It was taking weeks to get a hearing for a guardian. We’ve seen a lot of people waiting for a guardian. Nobody wants to live in a hospital unnecessarily.”

Patient placement delays can occur when outpatient dialysis services are needed, Stanley said.

“If you need outpatient dialysis, you have to have a place to go in your community because you need it frequently,” she said. “But I’m hearing there’s not a lot of capacity; there might be a lack of staffing at outpatient dialysis centers. There are also nurse shortages across the country.”

Placement delays can also occur when Medicaid patients need long-term care, Stanley said. 

“If they are a Medicaid patient and need to go to an assisted living facility, they need to be assessed by a state agency,” she said. “And only state employees can do that assessment. It takes weeks to get that assessment done. If we’re thinking of the average stay during COVID, that was around five days.”

Placement can also be difficult for patients with dementia, behavioral health issues, developmental disabilities, criminal background histories, and complex needs as they wait for other facilities to accept them, Stanley said.

Aging patient populations can present staffing/resource challenges as well, Whiteaker said.

“If you look at how our populations are aging, baby boomers are needing services now,” Whiteaker said. “A lot of people think they can age in their homes and that’s not what’s happening. This will be a continued challenge.”

Some long-term care initiatives received funding in the 2022 legislative session, but more is needed in the 2023 session, Whiteaker said.

“We applaud the legislative investments made in the 2022 session,” she said. “I think there’s a better understanding of the issue, particularly around the challenges long-term care raises for hospitals. It’s been a frustrating issue because the system is not working in the way it was designed. There’s still more to do. We’re in the beginning phase as far as amounts, but we know we’ll need more support.”

There was also legislation proposed in House Bill 2083 during the 2022 session that would have supported long-term care, but the bill was not passed into law. Stanley is hopeful related policies can be implemented in the upcoming session. WSHA will work with long-term care providers to determine supportive policies, and what their equipment/staffing needs are.

“We’ll work with them to figure out what the big and small initiatives we can work on together will be,” Stanley said. “We have frequent calls with them.”