The lack of rehabilitation facilities and post-discharge care is causing financial and operational burdens for hospitals as well as decreasing patient safety and outcomes, Robert Glatter, MD, an emergency physician at New York City-based Lenox Hill Hospital, and Peter Papadakos, MD, professor of anesthesia and critical care at the University of Rochester (N.Y.) Medical Center, wrote in a Forbes article.
Many hospitals are struggling to find placement for patients after they no longer need acute care, and the demand for rehabilitation facilities is greatly outstripping their supply. The American Health Care Association and National Center for Assisted Living found that 579 nursing homes closed from 2020 to 2023, and only three new nursing homes opened in 2023, compared to an average of 64 per year between 2020 and 2022. Over 48% of nursing homes have wait lists of days to weeks, and 21% have been forced to downsize.
Many patients who cannot transition to a program remain at the hospital.
"EDs are canaries in the coal mine for downstream bottlenecks," Jesse Pines, MD, chief of clinical innovation at US Acute Care Solutions, the largest physician-owned emergency medicine group in the U.S., said in the article. "When rehab beds are constrained, patients stay in the hospital longer. That means less hospital space for new, admitted ED patients, which increases ED boarding. When boarding increases, there's less space in the ED. The result is all patients wait longer, and ultimately suffer worse outcomes."
The bottleneck to discharge patients poses a patient safety, operational and economic burden on healthcare systems, Drs. Glatter and Papadakos said.
The staffing crisis among nursing homes is one of the causes for lagging rehab bed supply. CMS proposed new mandatory minimum staffing standards for long-term care facilities, but "it may actually add to the problem in the short term as a result of a reduced pool of qualified health workers," the physicians wrote. The changes needed may need to come by considering remote options and emerging AI applications.
"What's clear is that leaders in healthcare and government must urgently address this issue," Drs. Glatter and Papadakos wrote. "Patients deserve the opportunity to return to their best quality of life. Failure to do so may contribute to the decay of our healthcare system."
Editor's note: This article was updated Dec. 13 at 4:38 p.m. CT.