NH Hospitals are cracking— what is the state doing to help?  

  • ICU nurse Michelle Rheaume is shown in one of the six the negative pressure rooms for COVID patients at Concord Hospital in June 3. GEOFF FORESTER / monitor staff

Monitor staff
Published: 12/4/2021 7:24:20 PM

Hospitals in New Hampshire are hitting a tipping point.

Coronavirus-related hospitalizations have shot up while the number of licensed staff to care for these patients has steadily dwindled, leaving a healthcare system buckling under a growing surge of COVID-19.

New Hampshire hospitals are operating at 91% capacity, Department of Health and Human Services Commissioner Lori Shibinette said at a Fiscal Committee meeting Thursday. Even that number is misleading, she said, as the remaining 9% of beds could be in pediatric wings or maternity wards that only accept a specific demographic of patients.

She said hospitals are transferring people out of state, as far as Connecticut and New York, to find them available care.

Concord Hospital, which has 186 staffed medical surgical beds, currently has just three beds open. All members of the Dartmouth-Hitchcock Health System reported “marked increases” in active COVID-19 cases and are prepared to reduce or delay nonessential procedures if the surge continues to worsen, a spokesperson wrote on Wednesday.

Now, the state is looking to spend about $90 million to help.

Gov. Chris Sununu signed an executive order last week which tasks the Department of Health, the Board of Nursing, and the Office of Professional Licensing with finding strategies to address a healthcare system in crisis. Here are the ways in which the agencies plan to help under this executive order:

Hospital capacity

New Hampshire’s healthcare system has strained since the beginning of the pandemic to handle wave after wave of COVID-19. Now, it’s worse, Shibinette said.

Most large hospitals in the state are working over capacity, she said.

“It is much different now than what it has been in the last year and a half,” Shibinette said. “This is this is kind of the point that we wanted to not get to...”

The bulk of funding to address the healthcare crisis will go towards clearing out a backlog of patients, who remain in hospitals longer than needed while they wait for a bed at a long term care facility to open up.

Nursing homes and assisted living facilities — just like hospitals — are facing a dire shortage of licensed nurses that has forced many homes to close beds or take entire units offline.

Waiting lists for a nursing home bed can be hundreds of names long, which often leaves hospitals to use their coveted beds on patients who could be discharged to a lower level of care.

The Department will create eight “strike teams,” which will be composed of out-of-state nurses, nursing assistants, paramedics and EMTs who will be dispatched to long term care facilities across the state.

The hope is that the teams will increase capacity at long-term care facilities that have empty, unstaffed beds. Shibinette said a handful of long term care facilities have already expressed interest in reopening units that were closed due to staffing shortages. The state is expecting that teams will allow two sizable nursing home units to reopen.

The Department will also announce a plan to allocate strike times to hospitals next week, Shibinette said.

In addition, the state plans to financially incentivize long term care facilities and rehabilitation centers to accept older patients from hospitals. Rehabilitation centers would be paid their normal rates to accept patients waiting in the hospital for a bed in a long term care facility.

The funding, if approved, will also go toward paying providers who take patients while their Medicaid eligibility is pending approval, who would ordinarily wait in the hospital until nursing homes knew their care would be compensated.

Shibinette said the ultimate goal of these programs is to get hospital capacity below 80%, where it was before the winter surge of COVID-19.

Funding for these programs, which primarily comes from federal aid money, was approved unanimously by the Joint Legislative Fiscal Committee Thursday and will now go to the Executive Council for consideration.

Nurse licensing

Brian O’Hearn, chief nursing officer at Androscoggin Valley Hospital, said unlike the early days of the pandemic, when beds and supplies limited the number of patients they were able to accept, the number of licensed nurses are now the limiting factor.

“We’re realizing that the crisis point is really our staffing,” he said. “We have the physical beds, we have capacity, we don’t have the staff across hospitals to man the type of volume that we’re receiving right now.”

The Board of Nursing met on Thursday to find ways to expedite the nurse licensing process and send much needed staff into the healthcare system. O’Hearn was sent to the meeting on behalf of hospitals across the state to convey the urgency of the situation.

“From a critical care perspective, we’re over capacity in most, if not all, of the hospitals,” he said. “Each day I’ve been on that call and I’ve seen the situation actually become more perilous...If I leave you with the notion that it is a perilous position that we’re finding ourselves entering into, then that’s unfortunately a success for tonight.”

The Board voted to allow prospective nurses licenses to practice in New Hampshire while their background checks are processed. Lindsey Courtney, executive director at the Office of Professional Licensing and Certification, said the high demand for background checks has delayed the approval of many nurse licenses — prospective nurses typically wait two to three weeks for their background check to be processed by the Department of Safety.

“The demand for healthcare has significantly increased such that a two week time frame is no longer acceptable,” she said.

Courtney said according to a recent report, there are 829 records under the Board of Nursing that require completion. She said 89% of those applications are missing an FBI criminal history check and cannot be licensed under the existing requirements.

Courtney said it’s difficult to tell how many nurses this change will release into the workforce. Data on the number of pending licenses is muddled with abandoned and duplicate applications.

“The database, is like the Atari version of a gaming system,” she said. “It’s just awful.”

Courtney said her office is working to refine the data and evaluate other legislative solutions, including a bill that eliminates background checks from the licensing process. Courtney said the requirement is redundant, as most healthcare businesses run background checks before hiring a new employee anyway.

The OPLC and the Board of Nursing will submit proposed legislative and regulatory reform suggestions to the governor by Dec. 23.

“We just need bodies,” Courtney said. “We’re processing the licenses, but we just we need more people.”


Teddy Rosenbluth bio photo

Teddy Rosenbluth is a Report for America corps member covering health care issues for the Concord Monitor since spring 2020. She has covered science and health care for Los Angeles Magazine, the Santa Monica Daily Press and UCLA's Daily Bruin, where she was a health editor and later magazine director. Her investigative reporting has brought her everywhere from the streets of Los Angeles to the hospitals of New Delhi. Her work garnered first place for Best Enterprise News Story from the California Journalism Awards, and she was a national finalist for the Society of Professional Journalists Best Magazine Article. She graduated from UCLA with a bachelor’s degree in psychobiology.



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