The Arizona Republic

Arizona takes steps to solve patient bottleneck

- Stephanie Innes Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephaniei­nnes.

It’s a problem at hospitals across Arizona — a bottleneck of patients who have completed their treatment for COVID-19 and are ready to be discharged, yet are not well enough to go home.

Often, there’s nowhere for them to go. At least not right away. The situation is a major stressor on hospitals in Arizona as they contend with the pandemic.

Although the state had identified the recently shuttered, 225-bed St. Luke’s Hospital in Phoenix as a site for COVID-19 patients, it has not yet been put to use.

Instead, the Arizona Department of Health Services last week signed a contract with three long-term care facilities in Arizona owned and operated by The Ensign Group, a California-based company.

The contract requires the Ensign facilities to hold a total of 94 beds, at skilled nursing homes in Phoenix and Tucson, specifical­ly for post-hospital COVID-19 patients who need further care and are still testing positive for the new coronaviru­s, which causes COVID-19.

The state is hoping to contract for a total of 300 such beds, Arizona Department of Health Services Director Dr. Cara Christ told The Arizona Republic.

“What we had ultimately come to with St. Luke’s was that it was about 225 beds if fully brought up and staffed. So this will actually be more beds available in licensed, regulated facilities,” Christ said.

“This will clear up a lot of people sitting in the hospital because they don’t have negative (COVID) tests.”

Patients who have been seriously ill and hospitaliz­ed for COVID-19 may have a number of long-term issues, including breathing problems, muscle loss, general weakness and cognitive difficulti­es.

“Our post-acute care continuum is extremely busy. We are still caring for the patients that came to us at the highest point of the surge,” said Lynn Rosenbach, vice president of post-acute services at Banner Health, which is the state’s largest health care system.

Banner Health last week expanded the number of post-acute beds within its system through a partnershi­p with the Pennsylvan­ia-based company Select Medical and also will benefit from the state’s contracted nursing home beds.

“That definitely is an improvemen­t. Do we feel like we can rest? Absolutely not,” Rosenbach said.

St. Luke’s is ‘a last resort’

Although state health officials have secured an operator for the former St. Luke’s Hospital in Phoenix to care for COVID-19 patients, Christ said using existing, dedicated beds in nursing homes is a better solution for the patients needing post-acute care.

“We’ve got a contractor who could step in and run (St. Luke’s). It would run under the Arizona Department of Health Services. But that is kind of like a last resort,” Christ said.

Ensign facilities have experience with COVID-19 patients and are willing to take them, she said.

“From a patient advocacy standpoint, that is a much better place for our Arizonans to be than St. Luke’s,” Christ said. “St. Luke’s is there if we need it, and we are continuing to have security on it, to keep it operationa­l ... We’re ready to go if we need it. We just think this is a better alternativ­e.”

Arizona Surge Line will coordinate placements

The placement of patients in the post-acute care beds will be coordinate­d through the Arizona Surge Line, which is a 24/7 statewide phone line for hospitals and other providers to call when they have a COVID-19 patient who needs a level of care they can’t provide.

“This will be active, facilitate­d placement by the surge line,” Christ said.

An electronic system locates available beds and appropriat­e care, evenly distributi­ng the patients so that no one facility or system is overwhelme­d by patients.

Christ said the state is paying the long-term care facilities to hold the beds for COVID-19 patients. The state will also provide some hazard pay, but it is not paying for staffing costs, she said.

“We’re giving them a bed hold fee for beds that currently don’t have people in them, and then as we place them, they will bill the insurance and the program through HRSA (the Health Resources and Services Administra­tion) for uninsured individual­s,” Christ said.

“We’ll work with them if they can’t get the uninsured approved through HRSA.”

Dischargin­g patients still on ventilator­s

Banner Health has a 32-bed critical illness recovery unit in partnershi­p with Select Medical, which can take care of patients who have been discharged from the hospital but are still on ventilator­s.

“These patients are not going to come off the ventilator­s in the short term. They may be on this care for a month or longer ... They are at a level where they can be moved to a unit that specialize­s in this kind of care,” Rosenbach said.

“There are step-down units within the hospital, but these specialty postacute providers, at Select Medical in this case, specialize in this kind of care.”

On July 21, Banner and Select Medical expanded that bed count to 60. Already, 17 patients have been transferre­d into the newly added beds, freeing space in the health system’s regular hospital beds, Rosenbach said.

“We are using sophistica­ted data tools to identify which patients need to go to which level of post-acute care, and then we can act on that data as a team,” she said.

Other types of post-acute care for COVID-19 patients, in addition to nursing homes and critical illness recovery, are rehabilita­tion and home care, including hospice, said Rosenbach, whose job has been busier than usual during the COVID-19 pandemic.

“We experience this during flu season, too, but not to this degree,” she said.

‘Way too many’ COVID-19 patients in Arizona hospitals

Hospitaliz­ations of patients with confirmed and suspected COVID-19 in Arizona appear to have hit a plateau and may be declining. Last week, total hospitaliz­ations dipped below 3,000 patients statewide for the first time since July 1.

But the level of patients with COVID-19 in Arizona hospitals is still too high, hospital officials stress. Banner hospitals have converted private patient rooms into doubles. At Valleywise Health Medical Center in Phoenix, some COVID-19 rooms have four patients in them.

Hospitals are bringing in staff from out of state, and existing staff members are working extra shifts to keep up with the number of patients who are critically ill.

“The numbers, while they currently are a little better than a week ago, are not a good place for us to be. They are not sustainabl­e,” said Dr. Marjorie Bessel, chief clinical officer for Banner Health.

“There’s way too many COVID patients in our hospitals, which means there’s way too much COVID in the community ... There are many other nonCOVID patients out there right now who are not getting the care that they need because we’re at this level.”

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