Most patients at UC Davis Medical Center prefer not to stay in the hospital any longer than necessary. Families and friends also want to see loved ones get home rapidly. And the medical center’s care teams always want their patients safely discharged as soon as possible, too. They need the beds for that constant flow of patients who require UC Davis Health’s acute-care services, which include highly specialized tertiary and quaternary care.
But some patients can’t leave the hospital, even after being medically cleared for discharge. Their hospitalizations can be measured in months, and sometimes in years.
These are patients with nowhere to go or no one who will accept them.
“There’s a perfect storm of factors that keep a number of patients housed in our hospital for extraordinary, unnecessary lengths of time,” said J. Douglas Kirk, chief medical officer for UC Davis Health. “We have patients who no longer need our level of care, but don’t have the family or the resources, or the mental or physical capacity, to be discharged on their own.”
Kirk added that on any given day at the medical center, there might be as many as a dozen patients who’ve been hospitalized for more than three months without the need for specialty nursing care or the expertise of UC Davis’ highly trained physicians. These patients are in health care limbo, stuck in costly hospital rooms because other care facilities – more appropriate to their needs – cannot or will not accept them.
Extreme lengths of stay
Extreme length of hospital stay – defined as 100 days or more – is not unusual at an academic medical center like UC Davis. A premature infant who requires intensive neonatal care to survive and thrive needs a lot of time in the hospital. The burn patient who needs specialized treatments, physical therapy and skin grafts often requires months of care, too. UC Davis Health has unique expertise for these types of lengthy, acute-care cases.
Unfortunately, it’s also not uncommon for patients who don’t need a high level of care to face an extreme length of stay in the hospital. A year or more of unneeded hospitalization is not unusual. One UC Davis patient has been hospitalized nearly as long as a presidential term in office: four years.
The original medical needs of that individual and other extreme length-of-stay patients have been addressed. Now they have no one and no place to go where their chronic needs can be met.
Such patients typically have physical, cognitive, or mental health disabilities, sometimes all together. For these patients, living independently is impossible. They need a certain level of help and care, but not a hospital’s level of care. Finding placement is difficult, and sometimes impossible.
The challenges of patient discharge
It’s a task that takes case managers at UC Davis Health many months and, in some cases, years of work to find a viable option for placement.
“These are the most complex patient discharge cases anyone can imagine,” said Joleen Lonigan