The call comes in about four times a week.
Nursing home residents call in a panic because they were sent to the hospital for a medical or mental health condition. Then, when the hospital discharges the patients, the nursing homes won’t take them back.
It’s called “hospital dumping,” said Marilyn McCormick, regional coordinator for St. Louis City and County in the Long-term Care Ombudsman Office, which is mandated and funded under the federal Older Americans Act.
By law, skilled nursing facilities are required to give their residents a 30-day notice if they want them to leave the facility. As advocates for elders, the ombudsman team receives calls on any complaints or violations at long-term care facilities.
Nursing home administrators have various reasons for hospital dumping, McCormick said. Perhaps the residents require extreme care, or they have behavioral issues the employees aren’t trained to handle.
In any case, dumping the resident at the hospital is not the way to handle it, she said.
“They can’t just leave the resident in the hospital,” she said.
If there is a reason why its staff can’t meet a resident’s medical needs, the facility should call the Missouri Department of Health and Senior Services, she said.
At Barnes-Jewish Hospital, this case occurs about once a month, said Thomas Dinwiddie, clinical social worker at the hospital.
At Christian Hospital, in North St. Louis County, it happens “too many times not to be addressed by the State,” said Diana Tucker, social work case manager.
According to the state’s Department of Health and Senior Services, it rarely happens.
“We don’t see it as a huge problem,” said Kit Wagar, spokesman for the department. “We don’t see that many complaints.”
However, Wagar said the State can’t quantify the number of cases because citations are not searchable by the type of violation. One would have to look at the files of each nursing home. There is no easy way to find out how often this happens, he said.
Cheryl Wilson, director of the ombudsman services for the St. Louis Long-term Care Ombudsman Office, said the issue keeps her team running around in frantic circles all week, leaving them hardly any time to attend to other advocacy duties.
Who pays the bill?
Last week McCormick said she got a call about a woman who had lived at a nursing home for a couple years, and she recently went into the hospital. When it was time to go home, the nursing facility told the hospital she could not return because her cost of care was higher than the Medicaid rate. And the home had too many of these types of residents already.
“That’s discrimination,” McCormick said. “They already have residents in the same condition as she is.”
In this case, the administrators still had to give her 30 days of notice, McCormick said.
However, nursing home representatives said if they took every case like this, they would be broke.
Sheronda Brown, director of marketing at Northview Village nursing home on 2415 North Kingshighway Blvd., said the State gives Northview – Missouri’s largest nursing home with 310 beds – about $132 a day per Medicaid patient. The certified nursing assistants, who do most of the grunt work, get paid minimum wage.
“They will cite us for not taking these patients, when we will be losing money if we take them,” Brown said. “We do it sometimes because we care. I tell people, ‘Don’t rush to judge the city nursing homes.’”
Mental health spill
Both the ombudsman program and nursing homes are burdened with the surge in mental health patients.
The State’s mental health care budget is dwindling every year. With psychiatric facilities closing, the patients are now moving into the nursing homes, Cheryl Wilson said.
This year, legislators severely slashed funds for the State’s two remaining psychiatric emergency rooms, as well as long-term care for people with mental illness and home care for elders.
Brown said Northview has felt both the cuts and the resulting increase in psychiatric residents. Now Northview is planning on adding a floor that will be a “key-entry” floor to meet these special needs. However, Northview does not get more from the State to take care of these patients, though the care is more intense, Brown said.
McCormick said the most common call of “hospital dumping” is when nursing homes refuse to take patients back because of behavioral issues.
In these cases, the nursing homes will send the residents to hospitals with behavior units to get reassessed or have their medications regulated again. When the patient has been regulated, the homes will refuse them.
The facilities say they would rather be cited by the State than take the resident back, Wilson said.
Brown said that when Northview can’t manage certain residents, administrators send them to the hospital.
“Our goal is to stay compliant with the State,” Brown said. “The ombudsman office doesn’t understand that. We are not going to risk other residents getting hurt. That’s our responsibility.”
If the resident has done something violent, the nursing home can’t bring that person back. As Brown sees it, staff and residents can expect an immediate fight, and there is no 30-day notice for that. The hospital has to help them go to another facility, Brown said.
According to state regulations, the facility can do an “emergency discharge” if individuals’ safety is endangered.
Some people come out of prison and go straight into nursing homes, Wilson said. Nursing homes are allowed to do background checks, but it adds another expense.
“The problem is the staff members aren’t trained to take care of these residents, and neither are we,” Wilson said.
Nursing homes can deny a resident. But on the other hand, sometimes they don’t know they have a sexual offender in their facility until his parole officers comes by six months later, she said. The homes can’t issue a dismissal at that point because it’s past 30 days from admission.
Resolutions and solutions
The most common resolution is when social workers speak with the administration at the facilities to find out if the patient was given due notice, said Diana Tucker at Christian Hospital.
It’s surprising to her how many administrators are not aware that a patient must get 30 days.
Most of the time, the patients return to the facility and then she helps administrators find the patient another place to stay.
There are a few nursing homes in North County that are repeat offenders, Tucker said, but she wouldn’t name them. Because they are located in North County, near the hospital, those are the nursing homes they deal with most commonly.
The patients who are prime candidates for getting dumped are the wards of the State, Tucker said. They are elders who don’t have any family members, and they have legal guardians appointed by the State. Guardians are typically attorneys. When the residents go to the hospital, the guardians should be notified, but they rarely are, Tucker said.
And the patients are not informed that they have due process, she added.
“I feel the solution comes from more effective supervision from the Department of Health and Senior Services,” Tucker said.
“I understand they have a lack of staffing and case managers. But a lot of facilities are not being monitored as often and effectively as we would like.”
This is the second in a three-part series on African-American elders in St. Louis. The series is being developed through a fellowship with the New America Media Ethnic Elders program, sponsored by the The Atlantic Philanthropies.
