Many older patients occupy hospital beds. A follow-up care cannot be found for them in time. Many nursing homes no longer accept difficult patients. Experts speak of triage.
Mandy Klingsporn is under constant stress. She works as a social worker at the Agaplesion Bethesda Hospital in Hamburg-Bergedorf. She also has to coordinate the discharge of patients who require a lot of care. Her phone rings in the stairwell. Another nursing home cancels.
In particular, a 64-year-old patient has been employed by Klingsporn for weeks. After surviving pneumonia, he is actually a case for a nursing home and no longer belongs in the hospital. He used to be an alcoholic but is sober now. His relatives don’t care about him. In an interview with Klingsporn, she called all homes, even those that were far away Report Mainz. She sent 170 inquiries to homes for him alone and was unable to place him. Mandy Klingsporn currently has a total of 30 such patients on her so-called “long-stay patient list”.
This is not only a problem in Hamburg. Although there is no longer a medical need, older patients occupy beds in hospitals nationwide. That has an unrepresentative Report Mainz-Survey result. So far, 330 of around 1,600 clinics have responded, and almost 88 percent of them confirm that patients have had to stay in clinics for more than ten days beyond medical necessity in the past twelve months. Follow-up care could not be found for them in time, for example in a nursing home.
homes take difficult hospital patients not up
In the “Pro Seniore” facility in Cochem on the Moselle, Margarete Vehrs, the director of the residence, would have plenty of space for other residents, but she lacks the staff to look after them. Currently 20 of 70 beds are not occupied. She has to find a good balance, she tells us, “so that the staff aren’t overworked, but the residents are also well taken care of.”
A resident died during the night. That means: There is also a free nursing home place again. And many want that. Margarete Vehrs has eleven inquiries from hospitals from near and far on the table this morning. Due to the lack of staff, it now has clear selection criteria. “I look to see which residents are the least complex, with a maximum of care level 2 – difficult residents or care level 4 are currently not admitted”.
It doesn’t take long for her to review the hospital requests. In the end, the decision is easy for her. A woman can come. “Not a complex case. Care level 2, is still oriented. Can still do a lot by myself and independently,” says Vehrs Report Mainz. These are the residents that the employees would like to have.
Margarete Vehrs speaks of a sad situation.
age researcher: “It’s definitely a nursing triage”
Vehrs is thoughtful. “We never had to sort out which resident or which patient was admitted or not. That’s very, very sad,” she says. When asked if she would talk about nursing triage, she replies: “That’s a good question. It’s put harshly. But it doesn’t come close. I have to choose.”
Triage means selection or screening. Whenever there are too few resources for too many patients in times of crisis, triage is used. And unlike in normal everyday life, the patient who is worst off is not helped first.
The Bochum age researcher Tanja Segmüller from the University of Health has dealt intensively with the topic of triage in care. For her, the case is clear: “It’s definitely a care triage, because the people who need the least care have the greatest chance of getting a place in a home and those who need care the most, the Those in need of serious care are left behind in the clinic or are even, we call it bloody, discharged home without care.”
Federal Minister of Health Lauterbach spoke at the request of Report Mainz on the subject of care triage.
call for help from employees out of care bases
Monika Kunisch is confronted with care triage in her daily work, she tells us. She works at the care base in Ludwigshafen and advises those in need of care and their relatives. “We have to realize in our counseling that more and more people are being discharged from the hospitals who are not being cared for appropriately. We then often see in home visits that neither outpatient nursing care nor medical nursing care is guaranteed. And that is an emergency that you just can’t let go of,” says Kunisch in an interview Report Mainz.
That’s why she and five other advisors from care bases from all over Rhineland-Palatinate wrote a written call for help to politicians. “We speak of care triage because it’s easy to choose the services and facilities. They choose to relieve their staff, to protect their facility, and that’s where people in need of serious care fall through the cracks more and more often,” says Kunisch.
policy reaction
The advisors’ paper is now also available to the Rhineland-Palatinate Minister of Social Affairs, Alexander Schweitzer, SPD. In an interview with Report Mainz When asked if it was nursing triage, he said: “I wouldn’t use that word, because I just don’t see that we are already in the situation overall, looking at the actual situation. But the subject of skilled workers is pressing because of course and the issue of professionals is why care facilities say we have to see who we can take and can we take someone else.”
The President of the Federal Association of Private Providers of Social Services, bpa, Bernd Meurer can understand the call for help from the care base employees. Around 13,000 companies are organized in his association. Meurer literally: “If nursing homes cannot accept patients from the hospitals because they lack the staff. If outpatient services simply cannot listen to desperate calls for help from families at home and cannot help, then I can understand that you can do that here too feels there’s a triage going on.”
The Rhineland-Palatinate Social Affairs Minister Alexander Schweitzer, SPD, refers to the shortage of skilled workers.
Specialists urgently needed
Politicians and nursing associations agree that there is a need for action. “The whole system is getting weaker and weaker. Now is simply the time to get involved in a concerted action and not just make political statements, not just make models, but really determine the causes and simply intervene in the form of quick help before the ship drowns,” says bpa boss Meurer im Report Mainz-Interview.
The Rhineland-Palatinate Minister of Social Affairs, Alexander Schweitzer, does not believe in a short-term solution. “It’s an illusion to believe that you flip a switch and everything will be fine. What we’re doing in Rhineland-Palatinate is an initiative for skilled workers. We want to increase training capacities. We will certainly have to talk about working conditions.”
Impact on hospital emergency departments
Meanwhile, the situation is getting more and more threatening. It now affects us all, says the spokesman for the Agaplesion Bethesda Hospital in Hamburg-Bergedorf, Matthias Gerwien. “In order to be able to run their emergency room properly, they need a certain number of free beds in the house because they never know which patient will come in and need an inpatient admission. And if they can’t get up to ten percent of their beds free , because the patients cannot be transferred away, then we have a huge problem there. In such situations, we have to temporarily close the emergency room,” says Gerwien.
At the request of Report Mainzhow often that had happened in the past year, he replied: “I don’t have a number directly available, but it happens every month.”