With state leaders estimating that Connecticut’s winter COVID-19 surge won’t hit its peak until January, concerns about staffing and capacity at hospitals across the state are intensifying.
Hospital officials so far have said they are not pulling back on elective surgeries and outpatient procedures as they did in the spring – a move that allowed them to shift staff and other resources to the growing number of coronavirus patients. COVID-related hospitalizations on Monday reached 1,098, and industry leaders have said there could be as many as 1,700 this winter in a “best case” scenario.
Jennifer Jackson, president of the Connecticut Hospital Association, said facilities are reluctant to scale back elective surgeries because many patients had put off care during the spring, allowing diseases to progress and conditions to worsen. But she also acknowledged that the widespread cancellation of those procedures put hospitals – already hemorrhaging money because of increased expenses linked to staffing, personal protective gear and other supplies – in a financial bind.
Hospitals are still closing the books on their fiscal year that ended in September, but the losses are expected to be sizable. Officials have estimated that, systemwide, the facilities may have lost as much as $1.5 billion.
“There’s certainly been talk about elective procedures, but it’s really been focused on how do we make sure, to the extent possible, that we preserve them,” Jackson said. “Last spring, we really saw a negative outcome at two levels. We saw people coming into the emergency department with diseases that had progressed in ways that were heartbreaking, and that they didn’t need to if they had gotten intervention. … And also there are really significant financial implications. Hospitals took a devastating hit. So we are concerned about that, too.”
Marna Borgstrom, president and CEO of the Yale New Haven Health System, said a final audit is underway in her network, but she expects operating losses to be “in the vicinity” of $120 million.
That’s due to the suspension of elective surgeries and other procedures last spring, along with the health system’s decision not to lay off workers. Employees also received a bonus this year.
“If we were operating strictly from a financial standpoint, you never would have done that,” Borgstrom said. “But it is the right thing to do when this is a people business, and we’re dependent on people.”
Despite receiving more than $600 million in federal relief funds, hospital leaders say they still expect to come up far short this year. They have asked the state for $450 million in aid.
A spokesman for Gov. Ned Lamont said discussions are ongoing. A decision is expected to be made by the end of the year.
But support from the state could be far less than what hospitals are seeking.
“We’ve had a lot of conversations, and the number that the state has been talking to us about is $75 million,” Jackson said. “In the interest of moving forward … we do really need for it to be resolved soon.”
Staffing concerns
As of Monday, at least eight Connecticut hospitals reported staffing shortages to the federal Health and Human Services Department, data show. For privacy reasons, the data do not specify which hospitals raised concerns about staffing.
But industry leaders have talked about worker burnout and the growing number of employees who are falling ill.
“I think someplace where the entire workforce struggles is fatigue,” said Dr. Gregory Shangold, president of the Connecticut State Medical Society. “This has been going on so long, and it takes energy and time to put on the appropriate protective gear for every patient that you suspect [has COVID-19]. The hard part is overcoming that fatigue and remaining diligent.”
Some hospitals are considering anyone who arrives from a nursing home or university to be “under investigation” with regard to their COVID-19 status, Shangold said. That means always making sure that the proper protective equipment is worn.
“That’s probably one of the hardest things for the medical community and for the nursing community, is just to maintain that vigilance,” he said.
In the spring, as staff in Connecticut and throughout the Northeast contracted COVID-19, hospitals were able to hire temporary and traveling workers for support. But with coronavirus surges now happening across the country, those employees are in short supply.
“They don’t exist anyplace right now,” Borgstrom said. “The pandemic is so virulent in so many parts of the country that nobody is loaning out staff. They don’t have nurses or [physician assistants] or others to send to any of the many, many hotspot areas.”
For hospitals that do manage to secure the so-called traveling workers, the price tag is steep. Kaiser Health News reported that traveling nurses in New Jersey have earned as much as $5,200 a week, and in Sioux Falls, South Dakota, they can command as much as $6,200 per week. A recent posting for a job in Fargo, North Dakota, offered more than $8,000 a week, Kaiser reported. The most recent coronavirus surge has created a bidding war for these employees, with hospitals willing to pay high wages to get the workers they need.
In Connecticut, facilities have reported a shortage of phlebotomists, among other workers. Staffing of COVID-19 testing sites, which have seen long lines recently, has also been a challenge. Employees from other departments are being re-routed to the testing sites.
“The first challenge we’ll likely run into would be staff – doctors, nurses, the professionals who serve patients and who are on the front lines,” Josh Geballe, the state’s chief operating officer, said Monday. “Our hospitals are still performing all of their regular procedures, tending to the medical needs … that come up independent of COVID every day. And that’s critically important, because when we delayed care earlier in the spring, that had impacts for people. So we’re hoping to avoid that.”
“But if pushed,” he said, “there are procedures that hospitals would start to curtail.”
Hospital capacity
On Monday, about 60% of the state’s 1,042 intensive care unit beds were occupied, state officials said. About a third of occupied beds in the ICUs were COVID-positive patients.
Seventy-one percent of Connecticut’s 7,783 total staffed hospital beds were occupied.
The percentages vary by hospital. Officials at Yale New Haven Health said last week that across their system, 80% of the ICU beds were occupied (though not all were taken by COVID-19 patients).
Hospital leaders say there are fewer patients on ventilators than there were during the spring surge, and doctors are better prepared to treat people based on everything they’ve learned about the novel coronavirus during the last nine months.
But the recent influx of patients is still taking a toll.
“Regarding the numbers – unfortunately they are real, and they are adding to the stress of our staff,” said Dr. Tom Balcezak, chief clinical officer for Yale New Haven Health. “I know it’s difficult in the communities, but the spread that’s been happening is leading to hospitalizations, and that’s impacting our staff and our capacity. Currently, we are about where we were near the end of March.”
Coronavirus patients typically stay in the hospital longer than other patients. So as more people are hospitalized with COVID-19, capacity issues become more pressing.
“Before Coronavirus, if a patient with an exacerbation of congestive heart failure comes in … that bed in the hospital could be occupied for three or four days,” Shangold said. “If a patient comes in with coronavirus, they’re going to be in that bed for a lot longer. So you can see – because the length of stay in general goes up with coronavirus – there are going to be capacity issues. Hospitals are more likely to reach capacity.”
Officials in Gov. Ned Lamont’s administration said they are keeping an eye on the number of COVID-positive patients at hospitals, because those people require a higher level of care that can stress the system. They did not say if or when additional restrictions would be placed on indoor dining or gym visits, despite recent calls from some members of the medical community for more limitations to curb the spread of the virus.
“The level of hospitalizations we have in the state is much too high. We need to get that down, because it does create a lot of strain on the system and on the individuals” who work there, Geballe said Monday. “Remember, they’ve been at this for eight or nine months now, under very stressful circumstances.”