Israeli hospitals have no choice but to keep many elderly COVID-19 patients in coronavirus wards even after their condition improves due to a lack of geriatric post-hospital care, a report released Tuesday said. This puts an additional burden on a hospital system already strained by the rising number of coronavirus patients in serious condition.
The report was prepared by the so-called barometer task force, which monitors the state of Israel’s hospitals to ensure that they can continue functioning despite the climbing coronavirus infection rates in past months.
Geriatric patients currently comprise between 10 and 25 percent of hospitalized coronavirus patients, with the figure varying from hospital to hospital, the report said. It therefore urged “intensive efforts to build post-hospitalization solutions for these patients outside the hospitals.”
The patients mentioned in the report have recovered sufficiently to be released from medical centers but still require skilled nursing care that cannot be provided at home or by ordinary nursing homes.
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Ichilov Hospital in Tel Aviv, for instance, told the Health Ministry this week that of its 110 coronavirus patients, 25 are geriatric patients who no longer need to be hospitalized, but they cannot be released because the hospital hasn’t found anywhere to send them. The hospital subsequently announced that it would not be accepting any more geriatric coronavirus patients in need of skilled nursing care until it found a way to release its existing patients. Other hospitals have complained of similar difficulties.
But Health Ministry officials said the situation changes from day to day, and some of the report’s concerns are no longer valid. “There are over 1,000 geriatric coronavirus beds, and additional beds are currently being opened,” one said. “Our assessment is that some will soon be unnecessary.”
The report also warned that intensive care units are overburdened, despite the recent decline in infection rates. “In many hospitals, these resources have been completely exhausted,” it added. In some hospitals, especially small- and medium-sized ones, increasing the number of ICU beds is impossible.
The task force expects the number of patients in intensive care to keep rising in the near future, even if incidence of the virus declines, both because of the time lapse between the onset of symptoms and deterioration into serious illness and because seriously ill coronavirus patients require lengthy hospitalizations.
In some hospitals, the report added, seriously and even critically ill patients are being treated by medical staff who aren’t trained ICU doctors or nurses, and the ratio of nurses to patients is also too low. It said this is happening in part because patients aren’t being properly distributed among hospitals depending on where there is most space.
“Even though large hospitals in the center of the country still have the ability to increase their supply of intensive care beds, there’s a feeling in the field that it’s not possible to transfer seriously ill patients other than for ECMO treatment,” it said, referring to a special heart-lung machine used on patients in particularly grave condition.
On October 6, for instance, two small hospitals in the north were juggling 10 ICU patients each, which is the outer limit of their capacity, even as large hospitals in the center of the country like Ichilov, Sheba Medical Center at Tel Hashomer and Beilinson Hospital in Petah Tikva had only around the same number of ICU patients, despite their much greater capacity.
Due to the failure to move patients among hospitals, some patients who need intensive care are being treated outside the ICU, in ordinary coronavirus wards, by less skilled staff and in less than optimal conditions, the report added.