How do hospitals handle patients who have nowhere to go?

By Zack Budryk

 

Much has been made of the "frequent flier" patients who return day after day to the emergency room, but some hospitals have another pressing problem: patients who they can't discharge long after their needs are met. 

 

Earlier in 2015, the District of Columbia's George Washington University Hospital admitted five patients in one month who could neither make their own healthcare decisions nor get in touch with loved ones or advocates, according to the Washington Business Journal. While the average length of stay at the hospital is five days, GW Hospital had no choice but to keep the five patients in the hospital for a total of 300 days.

"We became like a hotel, a boarding house," GW Hospital CEO Barry Wolfman told the publication. "This person is taking up a bed that could be used to care for someone else who needs it."

Wolfman reported the issue to the D.C. Hospital Association and found GW was far from the only hospital in the District with this problem. As a result, area hospitals have formed a "Guardianship Task Force," seeking to address a problem that, while not new, is escalating as the population ages and the healthcare industry's mental health resources fray.

A variety of factors can lead to patients being left in the lurch, from language barriers to mental illness to simply being abandoned by family, according to the article. The first step in such situations is to find the patient's next of kin or, failing that, a court-assigned advocate, which can take weeks. Even if the court assigns an advocate, the appointed person often drags his or her feet to make decisions on behalf of the patient, Patricia Dillard, head of GW's care management department, told the publication.

An average day of inpatient care at District of Columbia hospitals costs $2,500, meaning such patients could be running up a multi-million dollar price tag for providers. The prolonged hospitalizations are also dangerous for the patients, posing unnecessary risks of falls or hospital-acquired infections.

Since establishing the task force, GW's care management team has created a toolkit to help hold guardians accountable, providing information about expectations and responsibilities. The task force meets monthly to collect data in search of trends and improve hospital-court relations to streamline the guardian appointment process.

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How do hospitals handle patients who have nowhere to go?