Jackson County asking state for field hospital, health care workers
Jackson County is sending a request to state officials for a field hospital and health care workers as the COVID-19 surge overwhelms local hospitals.
The request is being made on behalf of both Jackson and Josephine counties and the Asante hospitals in Medford, Ashland and Grants Pass and the Providence Medford Medical Center.
"We are in crisis as a health care system. We are asking for help. We are in crisis as a community because patients may not be able to access the services they need,“ said Dr. Jamie Grebosky, chief medical officer for Asante.
A regional hub for advanced medical care for Southern Oregon and Northern California, Asante expects it will have to deny hundreds of patient transfers from outlying rural hospitals this month, he said.
Whether they live in the Rogue Valley or come from further away, people who need surgery for cancer, heart conditions and other serious medical problems are being told they have to wait because Asante can’t take them.
“We have hundreds of surgeries that are canceled. Only the most critically ill patients that are going to die in a day or two are the ones moving forward for surgery. If you have a medical problem that won't lead to death within a week, you don't get surgery,” Grebosky said.
Asante has asked Jackson County officials to make a request to the state government that the state set up a field hospital to handle COVID-19 patients. The field hospital could potentially be set up at the Jackson County Expo, but details would be up to the state, Grebosky said.
If the state can’t respond to the request to set up a field hospital, the request will be passed to the federal government ― likely the Federal Emergency Management Agency, said Jackson County Senior Deputy Administrator Harvey Bragg.
Providence has been lending ventilators to Asante and the state provided some ventilators, but Asante is in the process of getting more through its supply chain, Grebosky said.
"We have enough ventilators to take care of patients, but we're getting more because we are quite sure we're going to be ventilating more patients," he said.
New COVID-19 patients are arriving at hospitals daily.
"We are in a place in this pandemic that we have not seen before,“ Grebosky said on Tuesday. ”We currently at Asante have 127 COVID-19-positive patients that are being cared for. We are seeing daily increases of 10 and 20 COVID patients a day."
Hospitals in Jackson and Josephine counties had 136 COVID-19 patients Tuesday, compared to a December 2020 peak of 85 hospitalized patients when COVID-19 vaccines weren’t yet available to the general public.
The COVID-19 surge will likely grow worse.
"We are concerned about us having 200 or 250 COVID patients in-house over the next week. The state's projections are that this will go on for several weeks, into September," Grebosky said of Asante hospitals.
Asante hospitals are already beyond capacity, with 65 patients who need hospital care unable to get into hospital beds. They’re being cared for in emergency departments, operating rooms and other alternative spaces, Grebosky said.
There also isn’t enough room to put people who need critical care in critical care beds, he said.
Meanwhile, 60 patients have recovered enough they no longer hospital-level care, but Asante can’t find nursing homes willing to take them. Instead, they’re taking up hospital beds while not getting the post-hospital care they need, like rehabilitation services, Grebosky said.
Grebosky said he would rather ease the strain on hospitals by discharging patients into nursing homes than have the state set up a field hospital, but the state hasn’t made progress on the discharge problem.
"We're talking about putting up a field hospital when there exists in our community physical capacity to manage these patients at post-acute care sites (nursing facilities) that is sitting fallow. Why on earth is the state not taking advantage of that physical capacity? Putting up a field hospital is a really tough thing to do,“ he said.
Grebosky said he sounded the alarm with state officials 18 months ago that hospitals faced a problem being able to discharge patients into nursing homes. He’s had lots of meeting with Oregon Health Authority and state Department of Human Resources staff, but said the state hasn’t taken significant steps to solve the problem.
"I've gone through the channels that we need to go through. We've been reticent to go to the newspapers about these kinds of issues because we want to make sure we're giving our state officials every opportunity to respond. I’ve had many meetings with OHA and DHS officials. Their answer is, 'We'll make sure our higher-ups know.' I don't understand why there hasn't been action taken," Grebosky said.
He said the state set up what’s called a decompression unit at a local nursing facility that was helpful. But it was supposed to take 45 discharged patients and only took about 30. Many more decompression units are needed.
In response to a request for comment from the Mail Tribune, OHA said to meet immediate needs, it maintains a 90-day contract with Hearthstone Nursing and Rehabilitation Center in Medford to provide short-term discharge placement from hospitals for individuals who need nursing home-level care.
The facility is staffed to provide 30 beds and 28 were full last week. The contract is for the facility to take 45 patients “when staffing is available,” OHA said.
Grebosky said there is a shortage of health care workers, but Asante was able to hire registered nurses by paying more and offering bonuses. He questions whether the state is paying enough to get nursing homes to take patients.
OHA said to address the long-term nursing home workforce shortage, the Oregon Department of Human Services approved rate increases for nursing homes so they can offer higher wages. The Oregon Legislature has passed initiatives to support workforce development and training.
Grebosky said certain nursing homes need to be designated to accept discharged COVID-19 patients.
Several local nursing homes did not respond to requests from the Mail Tribune to describe the challenges they face in accepting discharged hospital patients.
The Oregon Health Care Association, which represents nursing homes and other care facilities, said many sectors of the economy are facing critical workforce challenges, including long-term care facilities in Southern Oregon.
“Long-term care facilities are doing everything they can to retain and attract qualified caregivers and licensed clinical staff including increasing pay, offering bonuses and more. Right now, the workforce just isn’t there,” said OHCA spokeperson Rosie Ward.
Many facilities don’t have enough qualified caregivers to operate at full capacity, she said.
“One of the key causes of the workforce challenge is actually a shortage of housing,” Ward said. “We are hearing stories of caregivers accepting job offers and then having to rescind them due to not being able to find housing within a reasonable driving distance.”
Southern Oregon has long had a housing availability and affordability problem, but the situation was worsened by the destruction of more than 2,500 homes in the September 2020 Almeda and South Obenchain fires in Jackson County.
Ward said nursing facilities are governed by strict federal and state staffing requirements that mandate staffing levels based on the number of residents and their care needs.
“This means that if there aren’t enough qualified and trained caregivers available in the area to fill positions, a facility is legally limited in the number of residents they can care for, and this includes residents being discharged from hospitals,” she said. “To do otherwise, would compromise patient/resident safety and violate laws.”
Ward said Oregon continues to follow infection prevention protocols to limit exposure of residents when there is a suspected or actual case of COVID-19 in a long-term care facility. Facilities with a suspected or active COVID-19 case are restricted from admitting new residents until the test results are back or cases are cleared.
Statewide, there are more than 30 current COVID-19 outbreaks in care facilities and senior communities, including several in Jackson and Josephine counties, according to OHA’s weekly workforce outbreak report that was last updated Aug. 4.
Ward said long-term care facilities also have strict legal requirements around admitting patients from hospitals if they have symptoms of COVID-19 or have had exposure, including required quarantining and negative tests.
Grebosky said the state could change regulations that are limiting nursing homes’ ability to accept discharged hospital patients.
Ward said OHCA has been working with the state for months to find solutions to address the staffing shortage at nursing facilities while maintaining quality care for residents, including those recovering from COVID-19.
She said one solution has been to create recovery units around the state to accept COVID-19 patients without putting seniors at risk. There’s also a Southern Oregon pilot program to help caregivers get back to work by providing child care, transportation and other benefits for filling shifts at facilities.
Grebosky said the state had a COVID-19 recovery unit in Roseburg but closed it.
He would like the state to set up a team focused on the discharge problem. Asante could free up dozens of hospital beds if patients had places to go, he said.
Although COVID-19 is racing through the community, Grebosky said people can still protect themselves and the others by getting vaccinated. Full protection takes several weeks to achieve, but people have partial protection just two weeks after their first shot, he said.
“It’s never too late to get vaccinated,” he said. “I would strongly encourage people to get vaccinated. It’s a really, really good idea.”
For information on free vaccinations, visit jacksoncountyor.org/hhs/COVID-19/Vaccine-Appointments.