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NY City hospitals impacted by well patients they can't discharge

Robin Wulffson MD's picture
New York City, public hospital, Medicaid, healthcare costs, illegal immigrants

NEW YORK CITY, NY - New York City hospitals are currently absorbing millions of dollars in unreimbursed costs to provide care for patients who are well enough to be sent home. The problem: the patients do not have a suitable home to go to. The patients are either illegal immigrants, lack health insurance, or do not have suitable housing. Hundreds of patients with these unfortunate circumstances are languishing for months or years in New York hospitals; they are well enough to be sent home - if they had one - or to a less-expensive nursing facility. Care for a patient lingering in a hospital can cost more than $100,000 a year; however, care in a nursing facility can be provided for $20,000 or less.

“Many of those individuals no longer need that care, but because they have no resources and many have no family here, we, unfortunately, are caring for them in a much more expensive setting than necessary based on their clinical need,” noted LaRay Brown, a senior vice president for the New York City Health and Hospitals Corporation. Under state law, public hospitals are not allowed to discharge patients to homeless shelters or to the street. The downtown area of the city is particularly impacted. Hospitals in the area serve a largely immigrant population; many patients have no insurance or proof that they are legal U.S. residents. This information is necessary for both discharge planning and reimbursement.

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Other states are facing a similar situation. Medicaid usually reimburses hospitals for emergency care to illegal immigrants; however, it does not cover continuing care; thus, many hospitals in regions with large concentrations of illegal immigrants such as California, Florida, and Texas are stymied by where to discharge patients who are well enough to leave but do not have a suitable place to go. Acute care hospitals are designed for patients with significant illnesses. Hospital stays for patients for procedures ranging from childbirth to gall bladder surgery have hospital stays far shorter than a few decades ago. Providing care to non-paying well patients not only costs the hospital money it also drains resources. Even the portion of care covered by Medicaid has a financial impact; Medicaid is funded by taxpayer dollars.

Ms. Brown noted that patients fit for discharge from hospitals who do not have a suitable home often remain in the hospital more than five years. She estimated that currently approximately 300 patients are currently housed in New York City public hospitals or public skilled nursing homes; a few are housed in private hospitals.

Ms. Brown noted that one patient, a former hospital technician from Queens, has lived at the city’s Coler-Goldwater Specialty Hospital and Nursing Facility on Roosevelt Island for 13 years because the hospital has no place to send him. The patient, who is in his mid-60s, has been there since an arterial disease resulted in amputation of one leg below the knee and left him in wheelchair-bound.

Hospitals and skilled nursing homes are extremely expensive hotels. In addition to providing less comfortable amenities than a modest hotel they also are sources of life-threatening infections, such as methicillin-resistant Staphylococcus aureus (MRSA). Thus, prolonged hospital stays are not beneficial to these long-term residents.