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Shortage at nursing homes have left an increasing number of patients in hospitals

JUANA SUMMERS, HOST:

Nursing homes take care of a range of patients. Some may only need a few weeks of rehab. Then there are patients who need longer-term care, and those patients are having a much harder time finding beds in skilled nursing facilities. Lesley McClurg from member station KQED reports.

LESLEY MCCLURG, BYLINE: David Alter (ph) always thought he'd grow old alongside his wife, Lisa (ph).

DAVID ALTER: We were very social, and she liked to be fun and wacky.

(SOUNDBITE OF JOAN JETT AND THE BLACKHEARTS SONG, "I LOVE ROCK 'N' ROLL")

MCCLURG: They loved to go to shows together.

ALTER: You know, there was a Joan Jett phase, you know?

(SOUNDBITE OF SONG, "I LOVE ROCK 'N' ROLL")

JOAN JETT AND THE BLACKHEARTS: (Singing) Singing, I love rock 'n' roll, so put another dime in the jukebox, baby.

MCCLURG: Lisa taught elementary school, and the couple had two children. But over the years, Lisa changed. She started to forget things. She became edgy and irritable.

ALTER: She was kind of struggling to hold the job.

MCCLURG: In 2011, a doctor diagnosed Lisa with Huntington's disease, a genetic brain disorder that causes nerve cells to break down over time. She was 45. Eventually, she couldn't walk, eat or talk on her own. Alter remembers hearing her one night.

ALTER: And then you got this panic. And then hearing her fall and - she hit the wall and, like, broke a hole in the wall. Now she's bleeding. It's 2 in the morning or something like that.

MCCLURG: He knew it was time for professional help. He says he called hundreds of nursing homes in California. He wrote personal letters.

ALTER: I want you to meet my wife, Lisa - see picture above - a vibrant woman, wife, teacher and mother of two beautiful children.

MCCLURG: But no one said yes. He asked for advice from the Huntington's Disease Society of America.

ALTER: I was told, you just don't have the power to do this.

MCCLURG: Their best advice was to leave his wife in the hospital after her next trip to the ER.

ALTER: The hospital can make negotiations that you're never going to be able to do.

MCCLURG: So even though it was excruciating, he didn't pick her up from the hospital the next time she fell.

MAURA GIBNEY: I don't know anybody that's gotten into a nursing home any other way.

MCCLURG: Maura Gibney is the executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital.

GIBNEY: That's the only way.

MCCLURG: But 4 1/2 months later, Lisa was still there. Kaiser Permanente declined an interview, but in an email, they acknowledged that some discharges present challenges. That's also true for Scripps Mercy Hospital San Diego.

VALERIE NORTON: Some of the patients up here have been here for a really long time because we don't have anywhere safe to send them.

MCCLURG: Dr. Valerie Norton is an emergency medicine physician at Scripps.

NORTON: Behind this door is a patient that's been here for more than two years.

MCCLURG: The American Hospital Association reports that patients waiting to transfer to a nursing home spent 20% longer in the hospital in 2022 compared to 2019. Several factors are at play.

BRIAN MCGARRY: The number of nursing home beds have declined.

MCCLURG: Brian McGarry is a health services researcher at the University of Rochester. He estimates a 15% drop in capacity due to staffing shortages and closures during the pandemic.

MCGARRY: And so the nursing homes have become much more discerning and much more careful about who they're willing to accept.

MCCLURG: He says the hardest patients to place are...

MCGARRY: Patients who have complex medical needs, have intense personal care needs that are going to require a lot of staff time at the nursing home to really care for them, patients who are already on Medicaid.

MCCLURG: Medicaid is the state and federal insurance program for people with limited income or disability. It reimburses at the lowest market rates. But Craig Cornett, the CEO of the California Association of Health Facilities, denies that nursing homes are refusing entry based on insurance.

CRAIG CORNETT: The bigger issue has really been the workforce challenges. If facilities don't have an adequate number of staff, they have to reduce their census.

MCCLURG: Still, David's wife, Lisa, who is covered by the state insurance program, known as Medi-Cal in California, hasn't found a place in a nursing facility. They've been looking for three years. She's now 58 years old.

ALTER: You're just defeated.

MCCLURG: Eventually, Kaiser did find housing for her where she gets food and supervision but not specialized nurses or regular doctor visits. She needs a lot of help to eat because of her erratic movements.

ALTER: She doesn't have the care she needs. She's so tiny. She's so skin and bones.

MCCLURG: He says he's hired consultants, lawyers and written his legislators, all to no avail. For NPR News, I'm Lesley McClurg in Berkeley.

(SOUNDBITE OF ELHAE SONG, "KNOW") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Lesley McClurg