COVID-19 drives crunch for beds in Upper Valley hospitals

Valley News Staff Writer
Published: 10/28/2021 9:52:02 PM
Modified: 10/28/2021 9:51:57 PM

RANDOLPH — At Gifford Medical Center the record is 24.

That’s the number of calls it took Gifford employees to find another hospital to take one patient in need of a higher level of care than the Randolph critical access hospital could provide, said Dan Bennett, Gifford’s CEO.

In the past, Gifford could rely on the closest academic medical centers — Dartmouth-Hitchcock Medical Center in Lebanon and the University of Vermont Medical Center in Burlington — to take patients in need of critical care. But those hospitals, like others around the country, are now facing capacity issues due to a high number of COVID-19 patients and worsening illness due to delayed care amid the pandemic. Ongoing workforce issues also are playing a role.

The COVID-19 pandemic is “like a bomb going off in the middle of what was already a difficult situation,” Bennett said.

On Thursday, Vermont had 57 people hospitalized with COVID-19 and New Hampshire had 204. And at the start of the week, there were no adult intensive care beds available in the southwestern and Upper Valley part of New Hampshire, according to the New Hampshire Department of Health and Human Services dashboard.

While it’s possible that this wave of COVID-19 and delayed care will ebb in the near future, some of the factors contributing to the bed crunch have been going on for a long time. Bennett cited the region’s aging demographics, including the health care workforce, as well as the region’s rural nature, which can drive up rates of chronic illnesses.

In recent months, Gifford and other hospitals in the Twin States have had to cast a wider net to find a proper placement for patients they don’t have the resources to care for, such as those in need of critical care. Such patients may end up as far away as Boston; Springfield, Mass.; or Albany, he said.

Sometimes now it’s not possible to find an ICU bed for a patient who needs it, said Dr. Alison P.R. Kapadia, a Dartmouth-Hitchcock employee and Hanover resident who is emergency department director at Brattleboro (Vt.) Memorial Hospital. She noted that she was not speaking on behalf of either D-H or Brattleboro Memorial.

For years, Kapadia said she has had patients waiting in the emergency department for days and weeks for mental health treatment elsewhere. Now, she said, the same is happening for some medical patients.

When an appropriate bed in a bigger hospital is unavailable, Kapadia said she talks with patients and their families about the situation.

She lays it on the line: “We’ll continue to call and try to get you a bed. In the meantime, your best option is to stay here. Probably things will be fine.”

But she lets them know there is a possibility for long-term disability or death. “People are really like, ‘OK,’ ” she said. “ ‘Got it. Thank you for your work.’ ”

From there, she said the team gets creative and tries to consult with specialists elsewhere by phone, while keeping the patient hospitalized.

At times, she said, patients have ridden ambulances to and from DHMC for a procedure. That involves extra time, effort and money, is “not ideal and it’s dangerous,” she said.

“I just tell my doctors: You just do what’s right for the patients,” she said.

So far, she said, “I haven’t had any, like, tragedies at my hospital. I do think that is almost inevitable.”

Dartmouth-Hitchcock Health had 38 COVID-19 patients across the system, including 14 at DHMC on Thursday, said Dr. Jose Mercado, D-H’s COVID-19 response leader.

“This does add stress to our health care system and contributes to fatigue for our front-line health care workforce,” Mercado said.

Cascade effect

Delays in finding a critical care bed for one patient can have a cascade effect for other patients, said Dr. Joseph Perras, CEO of Mt. Ascutney Hospital and Health Center.

When Mt. Ascutney is delayed in finding a higher level of care for a patient, that can mean the patient remains in the emergency department so the providers there can care for them while they wait. But that can increase wait times for other patients seeking emergency care, Perras said.

The Windsor hospital’s emergency department is further challenged by a high number of patients awaiting a bed for inpatient mental health treatment. On one recent day, Perras said Mt. Ascutney had four such boarders in its emergency department. Three of them were children.

Then there’s crowding after patients are no longer in need of hospital-level care, Perras said. Nursing homes, which are facing their own staffing challenges, are sometimes unable to take patients, leaving some hospital beds filled with patients who no longer need to be there.

It “all depends on the next link in the chain to be functioning,” Perras said.

Hanover Terrace Health & Rehabilitation Center, a nursing home on Lyme Road, is “getting hit with the staffing challenge just like everybody else,” said Martha Ilsley, the home’s administrator.

When Hanover Terrace gets a referral, employees review the request to determine whether they have the staffing necessary to care for that patient, along with the facility’s other residents.

“Probably someone who (needs) a lot of care and (is) very complex (we) might not be able to take them right now,” she said.

She also noted that low Medicaid rates can make it difficult for facilities to pay the high rates that staffing agencies are currently charging for traveling nurses. It costs Hanover Terrace about $90 an hour for a traveling registered nurse, she said. Those costs mean that the facility might be more inclined to take patients who need short-term rehab, which is covered by Medicare and reimbursed at a higher rate.

“You need the staff,” she said. “You do what you have to do.”

While IIsley said Hanover Terrace has not had trouble finding hospital-level care when patients need it, she said there have been delays in scheduling appointments for outpatient care.

To address patients’ concerns with such delays, Dartmouth-Hitchcock Health last week issued a video outlining five tips for patients seeking care. In the video, Dr. Ed Merrens, D-HH chief clinical officer, advised patients who are put on hold when trying to reach D-H to try using the callback option; and to call between Tuesday and Friday, not Monday. He also urged patients to create myDH accounts online; schedule COVID vaccinations at a pharmacy or state-run clinic; and use D-HH virtual urgent care rather than in-person office visits.

Permanent fixes elusive

The bed crunch hasn’t escaped the notice of officials in both states. At times, New Hampshire patients are sent out of intensive care units to smaller hospitals “while the highest-complexity and sickest patients are ... at our larger hospitals with more specialists,” said Jake Leon, a DHHS spokesman.

State officials are in regular communication with hospital officials and have offered assistance with transfers and coordination between them as necessary, Leon said. DHHS officials also are urging hospitals to treat COVID-19 patients with monoclonal antibodies to avoid the need for hospitalization and decrease demand on hospitals, and to use team-based nursing models to increase capacity.

Meanwhile, the Vermont Agency of Human Services has recently launched efforts to open 80 additional beds in long-term care facilities and is temporarily working with the White River Junction VA Medical Center to provide inpatient mental health treatment for some adults.

“I anticipate that will be helpful,” Kapadia said of the state’s efforts, though she had not yet seen benefits on the ground. As a scientist, she said she knows it’s important to “measure your results.”

Solutions remain elusive for some contributors to the bed crunch. For example, the beds at the VA can be used only for adults with mental health issues, not for pediatric patients, which Kapadia said she also sees regularly in Brattleboro.

In the meantime, Kapadia has decreased her clinical time by half in order to reduce the stress she feels working under such challenging conditions.

“It’s just too much,” she said.

While Kapadia and others in health care in the Twin States said that COVID-19 is not alone responsible for the current problems, it isn’t helping.

The surge of hospitalized COVID-19 patients is “literally all it takes to push us over the edge,” she said.

Steve Ahnen, president of the New Hampshire Hospital Association, said hospitals need the community’s help to reduce the demand for care.

He urged people to get vaccinated against COVID-19. People with questions about the vaccine should talk to their medical provider, he said. He also asked that people wear masks in public, stay home when they are sick, get tested when they have symptoms and wash their hands.

All this is “so essential to combating this surge that we’ve seen over the last couple of months,” he said. “We need to find a way to bend that curve of COVID so that every patient who needs care can get the care that they need.”

New Hampshire Gov. Chris Sununu addressed the high number of hospitalizations in the state at a Wednesday news conference, predicting that the situation “will get worse.”

He said that hospital officials are working together to address patients’ needs. Some are delaying elective surgeries and procedures, and they’re prepared to enact internal surge plans as necessary, he said.

“We’re all in it together,” he said. “We’re going to hit some really tough points.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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