Bed Blockers in New York: Nowhere to Go, Patients Linger in Hospitals, at a High Cost

By SAM ROBERTS
Published: January 2, 2012

Hundreds of patients have been languishing for months or even years in
New York City 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.

As a result, hospitals are absorbing the bill for millions of dollars
in unreimbursed expenses annually while the patients, trapped in
bureaucratic limbo, are sometimes deprived of services that could be
provided elsewhere at a small fraction of the cost.

“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 LaRay Brown, a senior vice president for
the city’s Health and Hospitals Corporation. Under state law, public
hospitals are not allowed to discharge patients to shelters or to the
street.

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. Officials in New York City say they have many such patients who
are draining money from the health system as the cost of keeping
people in acute-care hospitals continues to escalate.

But even if Medicaid pays for some care, taxpayer dollars are
ultimately being consumed by patients who could be cared for in
nursing homes or other health facilities, and even at home if
supportive services were available. 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.

Patients fit to be discharged from hospitals but having no place to go
typically remain more than five years, Ms. Brown said. She estimated
that there were about 300 patients in such a predicament throughout
the city, most in public hospitals or higher-priced skilled public
nursing homes, though a smattering were in private hospitals.

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, Ms. Brown said. 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. The city’s public health system
declined to provide the names of any long-term patients or make them
available for interviews, citing confidentiality laws.

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.

Within days, he was well enough for hospital personnel to begin
planning for his release, but as an illegal immigrant (he had
overstayed a work visa a decade ago), he was ineligible for health
benefits. And no nursing home or rehabilitation center would take him.
Neither would his son in China nor the Chinese government, although
the hospital volunteered to fly him there at its expense.

Mr. Yu’s protracted hospital stay was first chronicled in an article
in The New York Times in 2008 about the treatment of uninsured
immigrants.

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.”

Mr. Yu said that the hospital had treated him well, but that he had
made enormous progress in regaining his ability to walk through his
rehabilitation regimen at Atlantis. He hopes to return to China when
he is well enough to be discharged.

“Here, I am very happy,” he said. “This is very nice — No. 1.”

New York Downtown serves a largely immigrant population, and many
patients have no insurance or proof that they are in the United States
legally, which is necessary for discharge purposes and eventual
reimbursements, said Chui Man Lai, assistant vice president of patient
services at the 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.”

Health professionals refer to them as “permanent patients,” trussed in
red tape and essentially living in hospitals already operating on thin
margins. In some cases, health care professionals say, grown children
leave ailing parents at the hospitals and go on vacation. Officials
call that practice a “pop drop.”

Though the problem is particularly severe in the municipal hospital
system, longtime patients place a financial burden wherever they end
up.

New York Downtown spends about $2 million annually for such patients
out of an operating budget of about $200 million. An acute-care
patient can cost the hospital more than $1,500 a day.

Hospitals are reluctant to complain publicly about such patients for
fear of being perceived as callously seeking to dump nonpaying
patients. 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.

Longtime patients, meanwhile, risk getting sicker because they are
exposed to diseases that fester in hospitals.

“At times there is a fine line regarding who meets the criteria to be
admitted to a hospital, but if there’s no way to immediately contact a
family member and the patient needs nonmedical help or is homeless,
you’re obligated to provide shelter,” said Dr. Warren B. Licht, who
recently retired as New York Downtown’s chief medical officer after
seven years to return to full-time clinical practice in the wellness
and prevention center that he founded there. “You can’t kick a patient
out of the hospital.”

New York Downtown, Dr. Licht said, has offered to pay for nursing home
care for patents who are uninsured and are illegal immigrants, but
care facilities are reluctant to risk taking patients for fear that
they would be saddled with unexpected and unreimbursed expenses.

“If the patient does not have or cannot obtain health insurance to pay
for the next level of care, other non-acute-care health facilities
won’t routinely accept a patient,” Dr. Licht said.

New York Downtown has four or five patients out of a total of 180 who
have no place to go, he said, adding, “It cost us several million
dollars a year in a hospital struggling to keep its head above water.”