Low Reimbursements, Staffing Shortages Create SNF Backlog in New England

Insufficient nursing home capacity — the result of low reimbursements, staffing shortages, and challenges in caring for patients in need — is to blame for a patient backlog at two affiliated hospitals in New Hampshire and Vermont, the Valley News reported Saturday.

The Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, N.H., had to hold patients for a total of roughly 400 “avoidable” days of inpatient care between January and May, Elias Loukas, DHMC’s medical director for care management, told Valley News. The hospital’s affiliate in Vermont, Mt. Ascutney Hospital and Health Center in Windsor, has had patients awaiting discharge tie up beds for a total of 1,000 days, CEO Joseph Perras told the publication.

Part of the problem is that the region has had several nursing homes close in the past several years, according to Valley News. Nursing home providers, however, said the issue is not an insufficient number of beds, but rather low Medicaid reimbursement rates, a workforce shortage, and the increasing complexity of patients.


In addition, a nursing home might not be the best fit for some of the patients hospitals are trying to discharge, the providers told Valley News. Nursing facilities are not as prepared to manage mental and behavioral health challenges as they are to handle short-term rehabilitation and long-term medical needs.

One patient category DHMC has struggled to place involves addiction — specifically, patients addicted to intravenous drugs who have developed infections requiring IV antibiotics, Loukas told Valley News. Others that are hard to place include patients without insurance and those who need legal guardianship because of a psychological issue.

SNFs are aware of the demand for behavioral health services, and some explicitly try to address the issue of addiction, while others specifically target hard-to-place patients.


But none of those facilities are in the New Hampshire-Vermont area. Hospitals are often backed up with patients who have complex mental and behavioral health needs that are not appropriate for nursing home care, Patricia Horn, executive director of Cedar Hill Continuing Care Community in Windsor, Vt., told the publication. And Vermont doesn’t have enough appropriate settings for such patients, she noted.

“It’s put hospitals in a very, very difficult position,” Horn told Valley News. “We can’t accept them if we can’t meet their needs by law.”

Written by Maggie Flynn

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