Stuck in the hospital: Guardianship backlog exacerbates capacity issues in Mass.

In Massachusetts, if a patient has not appointed a health care proxy, only a legal guardian is recognized to make decisions.

By Jericho Tran 

With hospital capacity increasing during the flu season, health care professionals are sounding the alarm on the need for legal guardians to help patients who have not filled out a health care proxy form.

In most cases, the situation is avoidable by filling out the paperwork and assigning a legal guardian in case something happens and you're not able to make decisions for yourself — but legal and medical professionals say in other cases, especially with the aging population, there are no friends or family available, so patients are literally stuck inside hospitals.

"The emergency rooms are full, and a lot of that are people waiting to be admitted to another floor of the hospital, but there's no beds," said attorney Brandon Saunders, a partner at BSK Law Offices.

Patients without legal guardians may be stuck inside medical facilities for months at a time, eliminating space for the influx of patients at the height of the flu season.

"The length of time to get a guardianship has increased, and people are sitting longer, and I think it's having a greater strain on the capacities of these hospitals," Saunders said.

In Massachusetts, if there's no appointed health care proxy, the only recognized decision-maker is a legal guardian.

Saunders, who goes into court to appoint a guardian for patients, says it can sometimes take weeks.

"We were about 1,000 petitions for guardianship last year," he said. "That's up from the year before, and up from the year before that."

In the meantime, those patients are unable to get the specialized post-acute care they need.

"It's just exacerbated, as I say, in the winter, when when we are experiencing a flu surge, so capacity constraints are even worse," said Michelle McGrory, the associate chief nursing officer for care transitions and rehab services at Beth Israel Deaconess Medical Center. "That also exacerbates our congestion in all of our emergency rooms across the state, because patients cannot be moved from the emergency room to these inpatient beds because patients are stuck and we can't discharge them."

In September, the Massachusetts Health and Hospital Association found that 38 hospitals across the state reported 50 patients were stuck in hospitals waiting for the appointment of a legal guardian — with that number only expected to grow.

"There needs to be either a funding source or a better pool of available guardians," Saunders said.

Hospitals are asking anyone who is eligible to be a guardian to volunteer. They also asking legislators to provide funding for a volunteer guardianship program.

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Stuck in the hospital: Guardianship backlog exacerbates capacity issues in Mass.