An unpleasant new report claims that many hospitals in major metro areas are struggling with the growing problem of “permanent patients.”
What’s a "permanent patient"? According to the New York Times they are mostly illegal immigrants or people who lack insurance or their own housing that the hospital cannot turn away.
The Times defines a "permanent patient":
...[someone who has] been languishing for months or even years in…hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.
Of course, having dozens of patients hanging around that long means these hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually.
Unsurprisingly, the majority of these "permanent patients" are illegal immigrants because, as mentioned in the above, they have no housing or family in the area.
"Medicaid often pays for emergency care for illegal immigrants, but not for continuing care, and many hospitals in places with large concentrations of illegal immigrants, like Texas, California and Florida, face the quandary of where to send patients well enough to leave," writes Sam Roberts of the Times.
What kind of cost are we talking about here?
"Care for a patient languishing in a hospital can cost more than $100,000 a year, while care in a nursing home can cost $20,000 or less [emphasis added]," Roberts reports.
Patients fit to be discharged from hospitals but having no place to go typically remain more than five years, says LaRay Brown, a senior vice president for New York City’s Health and Hospitals Corporation.
She says that there were about 300 patients in such a predicament throughout the New York City area alone, most in public hospitals or higher-priced skilled public nursing homes, though a few were in private hospitals, according to the Times.
“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,” said Brown.
The report goes on to cite an example where one patient from Queens, NY, has been at the Coler-Goldwater Specialty Hospital and Nursing Facility 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 cost him part of one leg below the knee and left him in a wheelchair, according to the report.
Or another example:
Five years ago, Yu Kang Fu, 58, who lived in Flushing, Queens, and was a cook at a Chinese restaurant in New Jersey, was dropped off by his boss at New York Downtown Hospital, a private institution in Manhattan, complaining of a severe headache. Mr. Yu was admitted to the intensive-care unit with a stroke.
Mr. Yu remained in the hospital for over four years until he was transferred last spring to the Atlantis Rehabilitation and Residential Health Care Facility, a private center in Fort Greene, Brooklyn, after the federal government certified him as a “permanent resident under color of law,” essentially acknowledging that he could not be returned to China and qualifying him for medical benefits.
“This gentleman cost us millions of dollars,” said Jeffrey Menkes, the president of New York Downtown. “We try to provide physical, occupational therapy, but this is an acute-care hospital. This patient shouldn’t be here.”
The fact of the matter is that hospitals in metro areas that host a large illegal immigrant population are unable to turn away patients who have neither insurance nor proof that they are in the United States legally-- two things necessary for discharge purposes and reimbursements, said Chui Man Lai, assistant vice president of patient services at a New York state hospital.
“These patients often arrive in the emergency room acutely ill and unaccompanied, and we have to treat them until they can be discharged safely,” Ms. Lai said. “The hospital is required, by law and its mission, to care for these patients.”
But even worse than “permanent patients,” those who essentially live in hospitals already operating on thin budgets, are what some refer to as "pop drops": grown adults leaving their parents at the hospitals so that they can go on vacation.
"Hospitals are reluctant to complain publicly about such patients for fear of being perceived as callously seeking to dump nonpaying patients," writes Roberts. "Elected officials are generally loath to be seen as encouraging illegal immigrants by changing reimbursement formulas. The issue was never addressed during the debate over national health care legislation."