As the two county hospitals’ emergency rooms are crowded, there is an increase in the number of patients that don’t need emergency care but spend months in hospital beds.

On average, patients who can’t care for themselves and don’t have guardians spend nearly 90 days in Baltimore Washington Medical Center while the hospital works with the county court system to have guardians appointed.

Advertisement

Until then, hospitals can’t discharge the patient, which are typically people with advanced dementia, family abandonment, adults with mental disabilities who outlived their parents, psychiatric illness or those with conditions that leave them incapable of communication, Beth Tingo, BWMC Director of Population Health, said.

There were 14 guardianship cases at BWMC in calendar year 2017, 16 in 2018 and, so far through 2019, there have been 19 cases. Since 2017, these cases combined, total over 3,000 days the patients waited for discharge.

“This is taking up beds for acute needs, like someone coming in for acute care,” Tingo said.

Kristen Frock, RN and manager of BWMC care management team, said it is not a problem unique to BWMC. “I think all Maryland hospitals are seeing this," she said.

But Frock said this “does not obstruct the flow of patients getting care at the hospital."

Anne Arundel Medical Center has also seen an increase in the past two to three years, Chief Nursing Officer Barbara Jacobs said. It is estimated that 18 guardianship cases have happened over the past two years, including the most recent in which the patient was there for six months, a hospital spokeswoman said.

Emergency departments have already become a source for more complex social issues, with AAMC and BWMC emergency rooms acting as a “catch all” for behavioral health treatment and socio-economic issues, according to the county’s most recent community health needs assessment.

The cases that fall under guardianship have to go through a “legal process appointing decision makers for someone who lacks capacity, unable to make decisions or care for oneself,” Tingo said.

Hospital case managers will try to track down relatives but if they cannot find someone who can, and agrees to, become an assigned guardian the hospital must go through the Anne Arundel Circuit Court to legally appoint two people: one who can make decisions on care and one who can make financial decisions.

Without someone with legal power for the patient to move them to a long-term care facility, these patients stay in the hospital beds that would otherwise be used for emergencies.

“We’ve seen a slow increase and we can’t pinpoint why in these last couple of years we are seeing an increase,” said Tingo.

Guardians who make personal or financial decisions can be family members, relatives or spouses unless court appointed.

“As our population ages and we have families scattered and are not local, we don’t have people surrounded by a large number of family members who can sweep in and care for them,” Jacobs said.

Frock also considered these types of cases to be part of a complex issue.

Advertisement

“I feel like these things have always existed but maybe family structures were different to care for loved ones who were incapacitated,” she said.

Families may not have a long-term plan for care and as a result members are left without care, she said.

Without a guardian, hospitals turn to the court system to find a way to treat patients and then discharge them.

Hospitals can petition the court to become a guardian but legally cannot become a surrogate decision-maker, explained Terri Charles, spokeswoman for the Maryland Courts. Surrogates could be the patient’s court-appointed guardian, spouse or domestic partner, adult child, parent, adult sibling and certain friends or other relatives, she said in an email.

Still, the state has a public guardianship system so if family or other caregivers are not able to serve as guardian the court can then appoint a public guardian, which can be a local department of social services if the patient is under 65 or a local agency on aging if the patient is 65 or older.

Last December, new court rules were added to allow for an expedited process for the appointment of guardians who would oversee people with disabilities in connection with non-emergency medical treatment, according to the Maryland Courts website.

As the case is presented to the courts, Jacobs explained that this deliberation can take months.

“In the meantime the patient is in the hospital and requiring no medical care but it means we cannot put another patient in that bed,” Jacobs said.

AAMC has 425 beds while BWMC has 272, according to their websites.

“Our (emergency rooms) are crowded and we have a patient who is in bed that does not need to be in that bed,” she explained.

Advertisement
Advertisement
Advertisement