by Steve Ahnen, New Hampshire Bulletin
March 2 marks the third anniversary of the arrival of the COVID-19 pandemic in New Hampshire. It was on that day that the first case of COVID-19 in New Hampshire was diagnosed.
And while strains of COVID have shifted and become more manageable, the challenges facing New Hampshire hospitals today remain as significant as they’ve ever been.
Three years ago, health care leaders had to pivot to address the COVID crisis, and they did so immediately. There was so much we didn’t know about this new, novel coronavirus, COVID-19. Reports from China, Europe, and elsewhere showed that COVID-19 was exploding and could potentially overrun our health care system and its capacity to care for these very sick patients. To help ensure that hospitals would have the capacity to treat every patient who needed care, national leaders were calling for the suspension of elective procedures.
Hospitals in New Hampshire and across the country paused those elective procedures in mid-March 2020 while they simultaneously worked to expand their overall bed capacity to meet what was anticipated to be overwhelming demand. Pausing elective procedures had significant and immediate consequences for patients and for hospitals and the health care system.
For patients, it meant delays to the kinds of ongoing, routine preventive health care that allows them to remain healthy, catch diseases early in their progression, and manage their chronic health conditions. For hospitals and the health care system, shutting down those elective procedures meant the loss of hundreds of millions of dollars in revenue on a monthly basis. Thankfully, Congress and state officials stepped forward to provide some financial relief and to make certain federal and state rules more efficient and effective to allow the health care system to meet the needs of the patients and communities who needed them more than ever.
We’ve seen waves and surges of COVID-19 over the past three years that have challenged our frontline caregivers like never before. Hospitals organized themselves through the New Hampshire Hospital Association to work with one another to support their colleagues and ensure that no one hospital would be unable to serve their patients and communities. When a hospital was in need of assistance, be that a small, rural hospital or a large, urban hospital, their colleagues were there to offer assistance to help them get through whatever challenge they faced.
We were able to get through those dark and challenging days not because of what one individual or institution was able to do on their own, but because of what we were able to do working together and with our partners at the local, state, and federal levels.
Safe and effective vaccines and therapeutics were brought to market helping to save lives, reduce suffering, and ultimately allowing us to achieve some level of normalcy in our lives. As we stand here in March of 2023, those moments from the darkest days of the pandemic seem so long ago. And while we are in a dramatically different phase of the COVID-19 pandemic today, the virus continues to claim over 400 lives each day in the United States and far too many here in New Hampshire.
So, yes, we are not where we were 12, 24, or 36 months ago, but there are still many challenges that continue to confront hospitals and will for the foreseeable future as they struggle to meet the growing demand for health care amidst one of the greatest workforce challenges we have ever seen.
While difficulties in recruiting and sustaining staff are everywhere, they have been severely exacerbated in health care. Prior to the COVID-19 pandemic, hospitals across the state were seeing a roughly 9 percent vacancy rate for registered nurses, but that has doubled to 18 percent. These shortages are not just in nursing, but across the board, from licensed nursing assistants to respiratory therapists and so many more.
Working in health care is a particularly stressful environment these days, with providers and staff routinely going above and beyond to meet demand. Given the workforce shortages and heightened need for health care services, hospitals have had to turn to temporary staffing agencies to fill positions to ensure patients are able to get the care they need. As a result of the skyrocketing fees charged by staffing agencies, hospitals saw an unsustainable increase of 133 percent in their contract labor costs from 2021 to 2022. Over the past several months, hospitals statewide are running at well over 90 to 95 percent capacity on any given day, and many even higher. We see this play out in many ways, but most visible to patients is in wait times across the system, most acutely in the emergency department.
Further challenging hospitals in serving their patients is the inability to discharge patients who no longer need the level of care they provide. When a patient is ready to be discharged to the next appropriate level of care, but the nursing home, skilled nursing facility, or rehabilitation center is unable to admit them because they don’t have enough staff to serve them, those patients remain in the hospital, taking a bed that another acutely ill patient needs.
In health care, we are surrounded by caregivers who are committed to the patients and communities they serve. They come to work every day with one goal in mind: helping their patients get the care they need so that they can live healthy and productive lives. But there is no question that they are facing some of the most difficult challenges they have ever faced in their careers, and that is saying a lot when put into context of what we’ve all experienced over the past three years.
When you come to the hospital or your physician’s office, please bring with you a heavy dose of patience and grace and know that your health care provider is doing everything they can to provide you with the highest quality of care because they care about you. The blue and white H behind your community hospital is, has been, and always seeks to be there for our patients and families when they need us most. To ensure hospitals are able to do that, we will continue to need assistance, resources, and new, innovative solutions.
We will continue to collaborate and lean on our partnerships that have helped us get through the darkest days of the pandemic. Working together, I am convinced we can do just that.
This story was written by Steve Ahnen, president of the New Hampshire Hospital Association and contributor to the New Hampshire Bulletin, where this story first appeared.
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