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Complex case discharge delays must be addressed

Our patients deserve better long-term solutions.

HANYS' SWAT 2019 program, Tackling Complex Case Discharge Delays, took place Oct. 23-24 in Saratoga Springs. A wide variety of stakeholders, including hospitals and long-term care facilities, policymakers, payers, and interest groups representing patients participated.

The concept of hospital discharge is simple: Once patients no longer need acute care at the hospital, they are discharged to their home or another level of care.

But what happens if the patient can’t go home and another facility will not admit them?

Unable to be discharged, “complex case patients” end up staying at the hospital for weeks or even months.

This problem must be solved – and quickly. These patients need more suitable long-term support.

Complex case patients deserve more appropriate options

Complex case patients have a variety of competing needs that make it harder to identify appropriate post-discharge placement options. These patients often have co-occurring medical and behavioral health needs as well as difficult social or resource requirements.

For example, one adolescent’s recent case had the following complicating factors:

  • the patient had a traumatic brain injury and bipolar disorder;
  • the rehabilitation center refused to take the patient back; and
  • the patient could not be discharged home.

Multiple state and local agencies became involved and 22 places denied referrals. The patient was ultimately discharged into foster care after spending nine months in the hospital.

 A Sept. 15 Times Union editorial shared the story of another teen, “Olivia.”

“The girl was taken to the emergency room in April 2018, but her mother refused to accept her back for fear another child would be at risk. The Clinton County Department of Social Services agreed. Neither her school district nor the state Office for People with Developmental Disabilities could find a residential school willing to take her. Nor would OPWDD provide in-home help for the girl's care.”

“Olivia” spent five weeks in the hospital until a suitable discharge option was identified.

The current system is failing these patients. They’re staying in emergency departments and hospital inpatient units that were never intended to serve as long-term residences. They are safe in a hospital, but that doesn’t mean they can or should stay boarded in the hospital forever.

Hospitals and health systems are working to find answers

Complex case discharge delays are on the rise. Many young patients face co-occurring issues, while older adults with complicated cases are living and needing care for longer. Despite the need for more care, state and community-based resources have declined, leaving more vulnerable people without a safe place to live and thrive.

HANYS’ member hospitals, health systems and long-term care facilities are partnering with policymakers, state agencies, community providers, patient interest groups and others to find solutions for individuals living in hospitals due to system failure. Solving this problem may require regulatory and statutory action, and community funding.

Stakeholders are evaluating the following next steps:

  • creating a senior-level inter-agency task force that helps triage individual cases, creates a clearly-defined escalation process and develops policy changes to address system-wide issues;
  • training hospitals on creating complex case clinical care teams to internally triage and address these cases; and
  • educating all stakeholders about when it is and is not appropriate to bring an individual to the emergency department.

This important work is ongoing. HANYS encourages legislators, the media and the public to learn more about this issue and push for change. We cannot allow these delays to continue. Society must provide better answers for these patients.