As emergency room doctors nationwide plead for help to ease patient overcrowding, the one federal program that could fix the crisis is poised to lose funding.<\/p>\n\n\n\n
Across the U.S., ER patients who need to be hospitalized find themselves stuck in hallways or waiting rooms, sometimes for days or weeks, before they are able to get further care.<\/p>\n\n\n\n
Marissa Long, 30, spent three days and four nights on a gurney in a busy Los Angeles ER hallway last March, separated from other sick patients just a few feet away by a thin fabric curtain.<\/p>\n\n\n\n
Long, a heart transplant recipient, was showing signs of possible organ rejection: trouble breathing and falling blood pressure. She needed to be admitted to the hospital, but there were no beds available<\/a>.<\/p>\n\n\n\n \u201cPeople were coughing and vomiting,\u201d Long said. \u201cI already have a low immune system. I was scared to get sick.\u201d<\/p>\n\n\n\n Last summer in Bangor, Maine, Michael Day had heard of ER hallways full of sick patients, hacking and sneezing; people left sitting for days on hard, plastic waiting room chairs.<\/p>\n\n\n\n He did not want to go to the emergency room, although the 75-year-old had no choice. Following a diagnosis of advanced esophageal cancer, he was rapidly declining. He was weak and jaundiced. His blood pressure was plummeting.<\/p>\n\n\n\n With no available room in the hospital, Day found himself stuck in the ER, twice. <\/p>\n\n\n\n On one visit, Day developed a bed sore from remaining stationary for more than 26 hours. During another, the ER staff started him on an IV to replenish his fluids and hooked him up to a blood pressure monitor while he waited to be seen by a doctor.<\/p>\n\n\n\n Once again, hours ticked by.<\/p>\n\n\n\n Day\u2019s wife, Kathy \u2014 a former ER nurse \u2014 said they were there so long that the batteries in her husband\u2019s blood pressure monitor eventually died. His IV ran out and dried up. The staff on duty, Kathy Day said, did not notice. <\/p>\n\n\n\n At that moment, Kathy Day uttered the sentiment echoed by countless ER patients across the country: \u201cThis is bulls—.\u201d<\/p>\n\n\n\n Emergency medical care is meant for one of two things: Treat a person quickly and send them home \u2014 stitch up a deep cut, perhaps, or determine that a high fever isn\u2019t a life-threatening infection, for example; or get the patient admitted into the hospital for further care.<\/p>\n\n\n\n Because America\u2019s health care system as a whole is woefully understaffed to care for an aging population rife with chronic illnesses, or to meet increasing needs for mental health services, patients show up in the ER and, without any place else to go, stay in the ER.<\/p>\n\n\n\n \u201cThere are fewer nursing home beds. There are fewer rehab beds. There are fewer psychiatric beds,\u201d said Dr. Ali Raja, deputy chair of emergency medicine at Massachusetts General Hospital in Boston. \u201cOur overall length of stay for inpatients has gone up. Since those patients are staying longer in the hospital, we end up having more boarders in the emergency department.\u201d<\/p>\n\n\n\n Ninety-seven percent of ER doctors said they experienced patient boarding times of more than 24 hours, according to a November 2022 survey by the American College of Emergency Physicians.<\/a><\/p>\n\n\n\n More than a quarter, 28%, of the ER doctors said patients were forced to stay in the ER for more than two weeks before getting a hospital bed. <\/p>\n\n\n\n \u201cThere have been instances where patients are literally waiting for several weeks to months,\u201d Dr. Aisha Terry, president of the American College of Emergency Physicians, said during a briefing in October with reporters. \u201cPatients are leaving early, or dying waiting.\u201d<\/p>\n\n\n\n Rising health care costs have forced health systems nationwide \u2014 often in rural areas \u2014 to shutter hospitals and other medical facilities in recent decades, according to the American Hospital Association<\/a>. Elder care centers have also been affected, especially during the pandemic. A report from the Bureau of Labor Statistics<\/a> shows that the number of workers in nursing homes and other care facilities fell\u2002<\/a>by 410,000 between February 2020 and November 2021.<\/p>\n\n\n\n Dr. Joseph Tennyson, president of the Massachusetts chapter of the American College of Emergency Physicians said he recently worked an ER shift in which he had patients on oxygen support \u201cwaiting hours for an ICU bed that didn\u2019t exist.\u201d <\/p>\n\n\n\n Raja said his ER has been operating at a level dubbed \u201ccapacity disaster\u201d \u2014 with at least 45 patients boarded at a time \u2014 for at least a year. On Jan. 11, the Massachusetts General Hospital ER reached an unfathomable level of boarded patients: 103. The situation prompted the hospital to ask its state health department<\/a> to approve an extra 94 beds to ease the overcrowding. <\/p>\n\n\n\n \u201cWe don\u2019t have a clear solution,\u201d Raja said.<\/p>\n\n\n\n On Jan. 15, 229 people across the state were boarded and waiting to get a hospital bed, according to the Massachusetts chapter of the ACEP. For comparison, on Jan 17, 2022, during the Covid omicron surge, 278 people were boarded. Neither of those numbers include patients waiting for space to free up on a psychiatric care floor.<\/p>\n\n\n\n Massachusetts is unique in that it keeps very good statistics on the number of people waiting for hospital beds. Many states do not. <\/p>\n\n\n\n Dr. Doug Jeffrey, president-elect of the Texas College of Emergency Physicians, said the situation \u2014 which affects ERs across the country \u2014 has \u201cgone from our typical organized chaos to an out-of-control crisis.\u201d<\/p>\n\n\n\n \u201cWe\u2019re treating people in the waiting room. We\u2019re treating people in the hallways. It\u2019s unsafe for patients,\u201d Jeffrey said.<\/p>\n\n\n\n Michael Day made several trips to the ER before passing away on Aug. 7. While his cancer was terminal, his wife Kathy, who worked 53 years as a nurse, is convinced that his condition worsened because of the delays in care. <\/p>\n\n\n\n \u201cThis is not patient care,\u201d Day said. \u201cIt\u2019s more like warehousing.\u201d<\/p>\n\n\n\n ER boarding has reached such a crisis point that some hospitals have begun to invest in a promising solution to ease the overcrowding crisis.<\/p>\n\n\n\n A federal program called \u201cAcute Hospital Care at Home,\u201d or Hospital at Home, is designed to free up hospital beds, allowing patients to recover in their own beds. It was started by the Centers for Medicare and Medicaid Services in 2020 to help ease hospital strain during the pandemic.<\/p>\n\n\n\n In the program, people who are sick enough to be hospitalized \u2014 but well enough to do basic daily activities, such as walk safely to a bathroom \u2014 are able to be cared for in their own home, with round-the-clock remote monitoring and twice-daily visits from medical personnel. The average length of \u201cstay\u201d is four days.<\/p>\n\n\n\n Florence Sparks, 80, of Pineville, North Carolina, jumped at the chance to be treated at home rather than stay any longer in an ER. Sparks was having trouble breathing on Jan. 15 and had already spent 17 hours in an emergency department. <\/p>\n\n\n\n Sparks has congestive heart failure \u2014 a condition in which the heart doesn’t pump blood effectively \u2014 and it was clear that she needed more care than the ER could provide.<\/p>\n\n\n\n Instead of waiting for an in-patient hospital room, her doctors utilized the Hospital at Home program, run by Atrium Health in Charlotte.<\/p>\n\n\n\n A community paramedic checked in on Sparks twice a day, adjusting her IV and her medications as needed \u2014 all in collaboration with her doctor.<\/p>\n\n\n\n Atrium Health says it\u2019s managing up to 60 patients a day in North Carolina through its Hospital at Home program, and aims to treat 100 patients daily by the end of 2024. Within the next 18 months, organizers project the program will free up 10% of their in-patient hospital beds.<\/p>\n\n\n\n \u201cIf we did not have Hospital at Home, there\u2019s no doubt in my mind, we would have people with longer delays for getting out of emergency departments,\u201d said Matt Anderson, senior medical director, Virtual Health at Atrium. \u201cWe know that there\u2019s strain.\u201d <\/p>\n\n\n\n Sparks was able to sleep in her own bed while getting hospital-level care.<\/p>\n\n\n\n \u201cI think they\u2019re more attentive,” she said. \u201cThey\u2019re not rushed to see another patient. They give you their undivided attention.\u201d<\/p>\n\n\n\n Colleen Hole, a registered nurse and head of Atrium Health\u2019s Hospital at Home program, called it \u201cthe model for the future\u201d and said it could help reduce costs up to 25%<\/a>. <\/p>\n\n\n\n \u201cIt\u2019s proven to be a model that works for our patients and works for our health system capacity challenges,\u201d she said.<\/p>\n\n\n\n