COVID-19 hospitalizations may be far below their earlier peaks, but many Oregon hospitals are in serious trouble. Staffing shortages and a lack of skilled nurses mean that most hospitals in the state are nearing capacity. And rising costs have led to one of the worst financial quarters of the pandemic so far for some hospitals. Becky Hultberg, CEO of the Oregon Association of Hospitals and Health Systems, joins us, along with Cheryl Wolfe, CEO of Salem Hospital.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud, I’m Dave Miller. COVID hospitalizations may be way below their pandemic peaks, but many Oregon hospitals are in trouble these days. Staffing shortages and a lack of skilled nurses mean that most hospitals in the state are nearing capacity, plus rising costs have led to one of their worst financial quarters of the pandemic. Becky Hultberg is a CEO of the Oregon Association of Hospitals and Health Systems. Cheryl Wolfe is a CEO of Salem Health Hospitals and Clinics. They both join me now. Welcome to Think Out Loud.
Becky Hultberg: Thanks for having me.
Cheryl Wolfe: Thanks Dave
Miller: Cheryl Wolfe first, can you give us a sense for capacity at Salem hospitals?
Wolfe: Yes, thank you. We’ve been over 100% bed capacity for more than a year now. Last week was the first time that we started to see some reduction in the 90%. Hospitals are considered full at 80-85%, just because of the normal movement of patients across the different kinds of beds that you have in an organization. So after a full year of this kind of capacity, and today as an example, we have 423 patients in our beds, and we have 31 of those are COVID, that COVID number is down from kind of our average 40-50 over the last several weeks, a little bit of a break, but still significant capacity issues as we try to care for our community.
Miller: My understanding is that you were so full recently that you actually had to turn ambulances away. How long did that last for?
Wolfe: We did it one day, on July 26th, for four hours. A little bit of history Dave, we have not diverted an ambulance since 2008. It’s very tough on EMS to try to take a rig to a different community and a different hospital, it takes rigs out of the community. So in 2008, when I was the chief nursing officer, I worked with all of our EMS agencies and for our chiefs to come up with a plan for even when we were pushed, how we would be able to work together to keep the rigs operating in our community, and patients coming to our hospital.
So this was a huge decision for us to implement, going back on divert if necessary. And so although we’ve only done it once, we’ve been very, very close multiple times, because of again, the impact of not just the COVID patients, but also the number of ambulances coming to our emergency room, and then really from all over the state, as we’ve remained open for the most part. Some other hospitals have not been able to do that, so ambulances wherever there’s an open emergency room.
Miller: This to me is the biggest mystery. Throughout all the first 2.5 or so years of the pandemic, you didn’t have to divert. And then 10 days ago or so, for the first time in the pandemic, you did, even though covid hospitalizations are nowhere close to their Delta or Omicron peaks. So what’s driving the challenges now?
Wolfe: Well, several things. And one is the pent up healthcare demands of people that put off healthcare. We’re seeing sicker and sicker patients that are staying longer in the hospital than what they did pre-pandemic.
The other major issue is that we have patients in our hospital that we have to keep because we have no skilled bed or adult foster bed that we can send them to, because those facilities are equally impacted with lack of beds, or lack of staff to be able to take care of those patients. And they’re not well enough to go home, they have to go someplace. So we end up holding those. Pre-pandemic, it was about 30 patients a day that we were holding, and now we’re holding 90.
Miller: Becky Hultberg, we’re hearing the perspective of one hospital system, a big one, in Salem. How common is what you’ve just been hearing from Cheryl Wolfe?
Hultberg: Cheryl’s experiences and the experiences of Salem Health are really shared by hospitals across the state. This isn’t a challenge that one community is experiencing, it’s really a statewide challenge. And to even expand that further, some of the challenges that hospitals are facing in Oregon are shared by our counterparts in other states as well. Washington, just north of us, has highlighted their significant capacity challenges. Idaho is struggling with the same thing.
If you think about COVID-19 as an earthquake, what we’re experiencing now are the aftershocks. And the aftershocks at times can be as destabilizing as the initial event. So it’s going to take the hospitals and health systems some time to kind of work back to a place of sustainability and a new normal, because COVID was such a challenge, and changed so many things so fundamentally, that it’s gonna be a while before we feel like hospitals and health systems are on stable footing.
Miller: So is it fair to say that statewide, or maybe region or nation wide, staffing is currently at the heart of this issue?
Hultberg: Staffing is one of the critical components of this issue. It is not the only factor though. And so if you think about what Cheryl just mentioned, one of the challenges facing hospitals is the inability to get patients out of the hospital to another care setting. Certainly, staffing is part of that challenge as well. If a nursing home doesn’t have adequate staff, they have a challenge accepting new patients. But I think we have to think beyond this as simply a staffing problem, and look at why our health care continuum isn’t working, and what we need to do to address it.
Miller: I’m curious about your metaphor, the earthquake one, saying that if COVID was an earthquake, these are aftershocks. Can you help us understand the link? If right now, skilled nursing facilities or adult foster facilities are full up and that’s leading to an inability of patients who are well enough to leave hospitals to go to those sort of step down places, how is that connected to the pandemic?
Hultberg: We saw a couple of things during the pandemic. First, the pandemic was really hard on health care workers. We all know that. We, in 2020, talked about the heroism of those workers who continued to do that job into 2021 and 2022. And that, I think, caused an exodus of folks from healthcare. Acute care hospital certainly was one care setting, but those kinds of stresses existed in other parts of the systems.
COVID was also financially destabilizing. And so we have lost some providers in some outpatient setting, so that the overall capacity in the system has been reduced due to COVID. And now, as we see people coming back to hospitals that are perhaps sicker than they would have been, they delayed care, the capacity in the system is so reduced that we’re just seeing bottlenecks everywhere.
And when one part of the system doesn’t function, it affects the entire continuum. If you rely on an EMS to take you to the hospital, you rely on hospital care to take care of you while you’re there, and then if you can’t go home right away, you need a place to be. And what we’re seeing is that parts of those parts of the system really slow down, it affects the entire system itself and ultimately affects the ability of patients to get care.
And that’s what’s at the heart of this. We can talk about systems all day, but when systems don’t function, it means that people aren’t in the right place to get the care they need. And so that’s why we’ve asked the state for help, to say we need some help temporarily because we have to make sure that patients today get the care that they need.
Miller: What exactly, what kind of help are you asking for from the state?
Hultberg: We’ve been in good dialogue with the Oregon Health Authority around, Cheryl mentioned, placing patients in adult foster homes, and we’ve asked for some incentive payments for those homes to give them some extra financial support so they can take more patients. We are in conversation with the state about state funding for temporary staffing to help either hospitals to staff, or alternatively, and I think this is the preference, to provide staffing at long term care skilled nursing facilities so that they can open up capacity. And we’ve also asked for support for the Oregon Medical Coordination Center, which is a center that is helping to coordinate movement of patients around the state.
So those are things that we’ve asked for. We’re exploring some other alternatives. At this point, it’s like let’s turn over every rock and make sure we have explored every alternative so that we can ensure that the patients that are seeking care today get the care they need.
Miller: Cheryl Wolfe, you recently added, if I’m not mistaken, a 150 bed tower to the hospital. But a floor or wing or a whole new building of a hospital is only meaningful if there are people there to staff it. Have you been able to staff it?
Wolfe: No. We conceived this building before COVID, and we expected to gradually fill these new beds over 10 years. That was the data that we had. Now COVID accelerated that another 30 to 60 beds at a time are dedicated to COVID, so we can staff that. We have a lot of contract labor that we brought at about three times the rate of hired staff, as we try to hire enough staff. But our plan was over a ten-year period to gradually build up that staffing to be able to staff all 150 additional beds. But no, we don’t have that staff today.
Miller: What Becky Hultberg was outlining, that long laundry list turning over every possible rock for help from the state, a lot of it to me sounds like kind of emergency responses, that there’s an emergency right now, we need help right now, so please figure out ways to help us right now, state officials. But it also seems like from what both of you are saying that what we’re looking at are potentially now, because of the pandemic, long term issues that might require long term solutions. So Cheryl Wolfe first, what’s your vision for what a sustainable future actually looks like?
Wolfe: Well, I think that Becky outlined it in terms of we need a very solid continuum of care for patients in our various communities. So I think what the pandemic revealed is where one part of the system doesn’t work well, then it bogs down the entire system. So having that continuum is really important. And so when I talked about 30 patients being held a day because of no place to go, and now 90, I think that 30 has to be unacceptable in the future to be able to build the right continuum for patients.
Miller: And Becky Hultberg, what about staffing? What do you envision in terms of a future Oregon healthcare world where there are enough healthcare workers of various kinds for various levels of care, and they’re people who have good enough jobs that they’ll stay in their jobs?
Hultberg: I think that’s the question that every hospital CEO, every association CEO in every state is really wrestling with right now. And I appreciate your question about how we’re addressing this long term, because we are in a crisis and we have to meet people’s needs today. And then we have to figure out how to fix the system so we’re not in this place in the future. And I think what that looks like on workforce is addressing the pipeline. There were some bills in the last legislative session that I think are a good start, but they’re not going to be the entire solution. So we need to continue to expand the pipeline of workers. We need to make it easier for out of state workers to come practice in Oregon. It’s too hard to get an Oregon license, it takes too long and we are at a disadvantage compared to other states because of our licensure structure.
And then I think we need to think creatively, long term. What if this is a chronic shortage? How are we going to continue to take care of patients to provide high quality care, if in fact it is a long time before that pipeline is full? I think those conversations are the hardest conversations, but we need to be thinking about that as well.
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