Nov 17, 2022 - Podcasts

Hospitals pushed to the breaking point

Hospitals are keeping patients longer than they need to, as healthcare worker shortages are making it hard to get some patients into long-term care facilities. Now, hospitals are looking to Congress for help paying for patients they can’t discharge. Meanwhile — emergency rooms have been overflowing in some parts of the country, and a lack of beds has left some to die in ER waiting rooms.

  • Plus, an update on action on Capitol Hill Wednesday, including a historic #MeToo bill being passed and the Respect for Marriage Act passing a key test vote.
  • And, the direction of the Ukraine war as it enters its 267th day.

Guests: Axios' Arielle Dreher and Neil Hauer, an independent journalist.

Credits: Axios Today is produced by Niala Boodhoo, Sara Kehaulani Goo, Alexandra Botti, Amy Pedulla, Fonda Mwangi and Alex Sugiura. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

Go Deeper:


NIALA: Good morning! Welcome to Axios Today!

It’s Thursday, November 17th.

I’m Niala Boodhoo.

Here’s what we are covering today: the current trajectory of the war in Ukraine. Plus, a groundbreaking #MeToo bill passes in Congress. But first, hospitals struggle to house patients - with deadly consequences. That’s today’s One Big Thing.

NIALA: Hospitals are keeping patients longer than they need to as healthcare worker shortages are making it hard to get some patients into longer term care. Now, healthcare facilities are looking to Congress for help paying for the patients they can't discharge. Meanwhile, ERs have been overflowing in some parts of the country and a lack of beds has left some to die in emergency waiting rooms.

Axios’ Healthcare Reporter Arielle Dreher has been covering this story. Hi Arielle.


NIALA: Ariel. Why are hospitals not able to discharge patients? What issues are they facing there?

ARIELLE: It's what I would call a perfect storm, right? We have staffing shortages in almost every level of our healthcare system right now, including, and especially in the long-term care system. So skilled nursing facilities and long-term care facilities, family group homes, those types of settings were really hit hard by Covid. And, subsequently hit hard by staffing shortages and so when there's not enough staff in those facilities, there's just not as much capacity and space for hospitals to discharge patients too.

NIALA: A letter was sent to President Biden, which was striking in that it talked about the literal life consequences of this. It was horrifying to read about nurses calling 911 because their ERs are overflowing, or ER doctors talking about patients dying in the waiting room because of this. What exactly do hospitals want Congress to do?

ARIELLE: The American Hospital Association is essentially asking Congress for a per diem payment for each of these patients that is staying there to sort of help alleviate their financial stress when it comes to backlog. Hospitals generally are dealing with a lot of financial pressures right now when it comes to losing some of the pandemic funding they were getting from Congress and treating patients that frankly are a higher acuity than they've seen in a long time, meaning they're seeing patients sicker than maybe they would've seen at this time in 2019.

I've talked to some clinicians and some analysts about this. We think part of that is because people delayed care during the pandemic. So people are coming to hospitals in emergency rooms sicker than perhaps they would've this time of year in 2018 or 2019, because they might have not got that checkup in 2020 or even 2021.

NIALA: Arielle, in your reporting, you found that skilled nursing facilities are still rejecting patient referrals from hospitals at higher rates than they did before the pandemic. Why?

ARIELLE: So it goes back to that staffing issue, right? And I talked to some consumers, the consumer voice, which are advocates for these long-term care patients. And in some cases, a facility rejecting a patient is actually a good thing, right? If a patient can't be safely admitted to a facility, we don't want them to take them on. And so it's sort of this push pull right now where you don't want a facility to be overwhelmed and have too many patients per staff member.

But on the other hand, in the hospital, these patients are sort of waiting and waiting and waiting. I talked to one hospital administrator and she's had patients upwards of 100 days at a time, and it's really difficult I think when the entire system is stressed as it is. Covid is not the reason anymore that these patients can't get into facilities. Outbreaks used to be the reason why transferring patients or referring patients was hard, but now it's simply a capacity and staffing issue.

NIALA: Arielle Dreher covers healthcare for Axios. Thanks.

ARIELLE: Thanks so much.

An update on action on Capitol Hill

NIALA: Some more updates from Capitol Hill.

Senate Minority leader Mitch McConnell was reelected to his leadership post yesterday after facing a challenger for the first time in 15 years. He beat Florida Senator Rick Scott, 37 to 10. And at a news conference, he addressed the GOP losses in the midterms.

MITCH MCCONNELL: We underperformed among voters who did not like President Biden’s performance, among independents and among moderate Republicans who looked at us and concluded too much chaos, too much negativity, and we turned off a lot of these centrist voters. Which is why I never predicted a red wave to begin with.

In a big win for the #MeToo movement, the House passed a bill yesterday - with bipartisan support - that limits the use of non-disclosure agreements in sexual harassment cases. The Speak Out Act is now going to President Biden’s desk to be signed.

And a bill that would codify protections for same-sex marriage overcame a big test vote in the Senate yesterday. A procedural motion passed with enough support to show the Respect for Marriage Act can pass in the entire chamber. Earlier this week - the law received an official statement of support from the Mormon church.

In a moment, an update on the direction of the Ukraine War.


The direction of the Ukraine war as it enters its 267th day

NIALA: Welcome back to Axios Today! I’m Niala Boodhoo.

An update on a story we’ve been following. Yesterday at a meeting in Brussels, Poland and the NATO alliance said that a Russian-made missile that crashed into Poland was probably a stray fired by Ukrainian air defenses and not from Russia - avoiding a danger of NATO escalation in the conflict.

But - NATO Secretary General Jens Stoltenberg said that the missile was not Ukraine’s fault and that Russia bears ultimate responsibility for its war against Ukraine. There have been about 66 civilian Ukrainian deaths just in the past two weeks – that’s according to the UN's Office of the High Commissioner for Human Rights.

That’s why we wanted to get an update on the trajectory of the war, which just marked its 267th day. I spoke last night with Neil Hauer, an independent journalist based in Armenia who’s in Ukraine right now covering the war. Hey Neil.

NEIL HAUER: Hi. Thanks for having me.

NIALA: So, we don't wanna lose sight of where the war stands at this moment. You are most recently back from Kherson, the Ukrainian city, where there was a recent withdrawal by Russian forces. Can you explain what the city looked like after it was liberated by Ukrainian troops and what this means for Russia? Right.

NEIL: You know, one of the most striking things about the city was that it was a remarkably good state in terms of, destruction, preservation, because, you know, there wasn't a prolonged fighting over it when the Russians took it in early March at the very start of the invasion. And then the Ukrainians were able to force the Russians to withdraw without extended urban fighting over the city. So it's physically in much better shape than a lot of other cities in Ukraine that have been at the forefront here. was really, surreal to be honest, to see the people there in the streets, against the backdrop of these Russian propaganda benders that are still hanging around the city on the billboards.

The people waving the Ukrainian flag and the sheer outpouring of emotion there. Over the last couple months, as Russia has increasingly the loss of military advantage, when they have experienced loss in the battlefield, they tend to respond with these sorts of strikes on civilian infrastructure. And I think it was especially Zelensky's visit, which was also on Monday, this week this one day later, they launched, by some accounts, their largest cruise missile attack of the war with over a hundred hitting Ukraine in just one day.

NIALA: What does the withdrawal of Russian forces from Kherson mean for Russian military strategy at this point?

NEIL: It's a move that they were gonna be forced to make sooner or later. Kherson city and the surrounding area lies on the other side of theDnipro River, across which there were only two bridges that Russia had to use to supply its forces there, and those were heavily damaged, hardly usable. So Russia was just going to increasingly lose more and more men in material sitting there on that side, and they would've been forced militarily to withdraw at some point.

NIALA: We talked about the missile strikes. Ukrainian power plants automatically shut down as a result of those strikes, leaving urban centers without electricity. What are you hearing about Kiev specifically, or major cities and electricity, how they're handling that?

NEIL: This has been the epicenter of the Russian strikes the Russians are focusing their efforts on Kiev. It has caused a lot of strain on the grid. There's rolling blackouts here and some districts are without power for hours at a time. But the Russian guided munition stock is declining over time.

NIALA: What's daily life like in Kiev right now?

NEIL: There's curfew at 11:00 PM. During the day, it's a functioning city when, about three weeks ago there was a very heavy Russian attack by Iranian suicide drones here and by the number of the people in the streets. You know, you hardly would've known it, drones, hit in parts of the city. You can even hear the explosions in the distance sometimes, and people hardly react at this point. It's just a facet of life. They've seen how the Russians are getting weaker. I think every Ukrainian across the country with tears in their eyes, tears of happiness. They were watching the scenes of liberation from Kherson, which were just incredible. People are more determined than ever.

NIALA: Niel Hauer is joining us from Kiev. He's an independent journalist. Thank you for being with us.

NEIL: Thank you so much.

NIALA: That’s it for us today! I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

Go deeper