Imbalance

Oregon hospitals face a structural imbalance. It’s like ticking through a long list of things that could go wrong, going wrong.

Oregon has the second lowest number of hospital beds per capita at 1.6 per 1,000.

The total number of patient days increased from 2017-2022 by 20%. And though it varies by region, hospital bed staffing capacity is below the licensed capacity. It’s at about 78%.

Then as if that structural crunch was not enough for hospitals, there are barriers that get in the way when hospitals attempt to discharge patients to a place for post-acute care. It’s a structure bent toward making every patient a challenge.

Many people ready for discharge from the hospital have complexities that can entangle their treatment. Obesity is the most common problem – 30% of patients. That is followed by serious mental illness for 27% of all discharges. Of those with serious mental illness, more than half are over 65.

The critical staff members – the case managers – charged with monitoring and caring for many of these patients also face trouble. The average length of tenure in the job is dropping. The rate at which case managers leave their jobs is trending up. Their wages have fallen behind inflation. And while the total number of case managers has increased along with the number of cases, their cases are becoming more complex.

We pulled this information from an agenda item of a state legislative committee – the Joint Task Force On Hospital Discharge Challenges. It is meeting this week to help the state find some answers.

Many states are trying solutions. Washington state has stepped up support for case managers. Massachusetts has set up support teams to help with hospital discharges, focusing on patients with a need for skilled nursing who have housing issues.

Oregon’s task force has a half a dozen more meetings scheduled this year. It looks like it will be aiming for changes to simplify coverage and benefits, to consider ways to help case managers get reasonable pay and to perhaps modify licensing for providers so licensing doesn’t get in the way of patient care.