PORTLAND, Ore. — As CEO of the Oregon Association of Hospitals and Health Care Systems, Becky Hultberg has a close-up view of the crisis gripping the state's health care sector — and she spends sleepless nights thinking about what the future holds.
More than two and a half years since the start of the pandemic, hospitals and skilled nursing homes continue to face historic staff shortages, and it's left Oregon's hospitals and health care systems in deep financial turmoil.
"Like many of you, I have family members whose lives have been saved in hospitals," Hultberg said. "And it feels really scary and desperate to me to think about living in a place or being in a time when there's not an emergency department bed that's open in a reasonable time, or there's not a hospital bed available when someone I love needs that care."
That's not hypothetical, she added — at many Oregon hospitals, it's a real and current scenario. Laura Hennum, CEO of Samaritan Hospital in Corvallis, agreed and said the problem comes down to staffing levels.
"When I left the hospital last night, our emergency room was at 143% of capacity," she said Thursday. "When I got in this morning, we were holding multiple patients in our ER. So, when folks say you don't have enough beds, we physically have enough beds, we don't have enough staff."
Hultberg and Hennum were guests on this week's episode of Straight Talk to discuss the hospital crisis, what caused it and possible solutions.
'A generation to recover'
Hultberg said she's heard from people who've been in health care for 30 or 40 years that they've never seen anything like what's happening right now. The Oregonian recently reported that collectively, Oregon hospitals lost $103 million in the first quarter of 2022.
"I think the word "existential" is a really good way to describe the crisis. It's really unprecedented," she said. "It's really a perfect storm of staffing challenges, severe financial problems, and an inability to discharge patients to move them to the next level of care."
Even though COVID-19 cases are currently at a low point, Hennum said — about 25% of the level where they peaked in 2021 — hospitals continue to feel what she called "the long arm of COVID-19."
"Many individuals will say to me 'it's such a wonderful thing the pandemic is over.' And you don't want to be negative, but you have to be realistic," she said. "Some experts are saying it's going to take a generation to recover."
The health care system is getting hit with pent-up demand for appointments and procedures, Hennum said, because many people were reluctant to seek treatment during the pandemic.
At the same time, many health care workers have chosen to retire or leave the profession, and Oregon is no exception to that trend. Of the roughly 3 million nurses nationwide, it's expected that half a million will retire by the end of 2022, she said.
"So, when you take that down to a state level, to a county level, to a community level, there are times with certain cases, surgical cases, that we can't put on the schedule because we are missing a key nurse," Hennum said.
The pandemic — and a self-inflicted wound?
The pandemic took a heavy toll on the hospital and long term care workforce, Hultberg said, both physically and psychologically.
Nurses and health care workers showed up and gave their all during the peak of the pandemic in 2020, she said — and citizens called them "heroes" and celebrated them.
But that was two years ago, and as the pandemic dragged on and hospitals continued to fill up with COVID patients, it became "hopeless work."
"Many of those patients didn't survive. It was hard. It was morally hard," she said. "So I think we are seeing the impacts of that now, where people have just said 'I can't do this work anymore. I'm going to go do something else.' We are seeing staff shortages everywhere, but particularly in hospitals, it's been significant."
Many health care workers have also spoken out about the crisis, but some of them have been critical of hospitals sounding the alarm, calling the situation a self-inflicted wound that hospitals could have been prevented by hiring more staff before the pandemic and doing more to keep current employees happy.
Hultberg said she sees it differently, and that hospitals nationwide are experiencing similar versions of the same crisis. It's going to take everyone working together to solve it, she said.
"If we are going to climb out of this and make sure we are going to continue to serve our communities, we are going to have to keep the focus on patients," she said. "We are going to have to do our best to take care of our workforce and we are going to have to work together, stop pointing fingers, come to the table and collaborate."
Short and long-term fixes
Hennum said solutions to the crisis, whether short-term or long-term, have to start with attracting more people to join the health care workforce.
"I can't think of any more meaningful work right now than health care," she said. "We have to find ways to invite (people to health care), especially those just deciding how they want to spend their work lives. We have to be able to share the value of that work again. And we have to succeed in doing it."
Another short-term solution is to ask for assistance from the state. The Oregon Health Authority and the state Department of Human Services have sent requests to the legislature's emergency board for nearly $40 million to address the hospital crisis.
Hultberg said the money would be used for incentive payments to adult foster care homes that will help discharge people waiting in hospitals for a lower level of care. Funding would also provide limited staffing support for skilled nursing facilities and for hospitals.
"I look at those things for what's going to help us now during the flu season over the next few months," Hultberg said.
The 2023 legislative session will also look at measures to address workforce shortages and post-acute care, Hultberg said — but a long-term fix is going to take a lot more work.
"I think it's time for us to sit down together as an industry and other stakeholders to say what has changed since the pandemic, and how do we chart a new course for health care that is sustainable and provides the ability for us to have what we all expect, to have an emergency department, functioning hospitals, and a good system for all of us." she said.
Having emergency care and hospital beds is not a guarantee, Hultberg added, but she emphasized the commitment of Oregon's hospitals to serving their communities.
"Oregon's hospitals are committed to being there for you and your family today and to being assets in your community for the next generation," she said. "But we are going to have some really hard work to do. And we are going to need help."
Straight Talk airs Friday at 7pm, Saturday at 6:30pm, and Sunday at 9:30pm.
Straight Talk is also available as a podcast.