Boise’s assisted living centers remain full, leaving many patients stuck in hospitals

On any given day, St. Luke’s Health System’s hospitals in the Treasure Valley will have multiple beds full of older adults who are perfectly healthy.

It’s not that they’re sick. The hospitals have nowhere to send them.

Dr. Alejandro Necochea, a physician at St. Luke’s, said these patients might have entered the hospital because of a health emergency like COVID-19. They often require assistance in day-to-day activities – preparing meals, maintaining personal hygiene, moving around – which are best performed at assisted living centers, outside the walls of the hospital.

But the lack of space at these centers means patients sometimes wait weeks or even months before they can leave the hospital. They remain in a hospital bed, waiting until a space opens up for them on the outside, for as long as 90 days, Necochea said.

“Patients are frustrated,” he said by phone. “They want to be able to leave the hospital. They want to be able to be close to their families.”

There aren’t enough beds at assisted living centers and nursing homes in the Treasure Valley to meet the growing demand. The COVID-19 pandemic and staffing shortages have limited how many residents assisted living businesses can take on, those in the industry told the Idaho Statesman.

The shortage is one piece of the broader problem of increasingly unaffordable housing in the Boise area. It comes as many older people, who often lived on fixed incomes, struggle to find housing in Boise’s ever-tightening market, where Apartment List reports that the median one-bedroom apartment now rents for $1,026 per month.

Robert Vander Merwe, executive director of the Idaho Health Care Association, said many Treasure Valley families are struggling to find spaces for their loved ones.

“It’s devastating,” Vander Merwe said. “There are enough family members going through this in Boise to fill Bronco Stadium.”

The reasons are many, but local experts say the high cost of assisted living, which isn’t typically covered by Medicare, and staffing shortages are two of the main factors.

Vander Merwe said costs in the Treasure Valley range from $3,000 to $7,500 per month, the latter for centers with 24-hour nursing care. That’s $36,000 to $90,000 per year.

Medicare doesn’t cover long-term care in assisted living centers and nursing homes, and Medicaid pays out so little for patients that many centers do not accept Medicaid patients, he said.

Nursing homes can be even costlier: A semiprivate room in Idaho averaged $8,669 per month in 2020, or $104,028 per year, and a private room averaged $9,125, or $109,500 per year, SeniorLiving.org reported last year.

But neither assisted living nor nursing-home care is as costly as hospitalization — though certain hospital stays are covered by Medicare, Medicaid and private insurance. In some cases, family members have to take in their loved ones when they can’t afford a hospital or a nursing home, Necochea said.

Dan Richter, managing member of the company developing the Avimor planned community off Idaho 55 north of Boise, said Avimor wants to invite operators of assisted living centers to build in the development, so residents have a nearby place to live when they get older.

But worker shortages for those who would staff these centers — particularly nursing assistants — have put a dent in that prospect. That combined with cost puts these centers beyond the reach of many, Richter said.

“We’ve got to find some way of making them affordable and solving our staffing problems, otherwise I don’t see a whole bunch of them coming online,” he said.

Jackie Kan, administrator at the Aspen Valley Senior Living at 4455 E. Warm Springs Ave. in Boise, told the Statesman by phone that her center has a waiting list for spaces and receives calls every day about their availability.

The lack of space in assisted living centers, and its reverberations on hospitals, have been problems for years. But the pandemic made them worse, Necochea said.

COVID-19 hit Idaho’s nursing homes and assisted-living centers particularly hard. State officials said in December that residents of these centers accounted for around 25% of all COVID deaths in the state, totaling more than 1,000 people.

Many centers haven’t survived. Thirty assisted living centers around Idaho have closed their doors in the past year, Vander Merwe said. That’s more than 10% of all the centers in the state.

Vander Merwe said smaller centers, with only one to two dozen beds, were particularly likely to close because of rising costs and smaller staff sizes. He said increased wages and patients relying on Medicaid left many smaller centers unable to meet keep up with the rising costs. The demand became too much for some owners.

“The owners were working 24 hours a day sometimes,” he said. “They were working every night plus answering emails during the day. That takes a toll on anyone.”

The assisted living shortage also adds to the number of elderly people facing homelessness in the Treasure Valley. Interfaith Sanctuary Executive Director Jodi Peterson-Stigers said the shelter has seen an increasing number of older residents entering the shelter system, mirroring a nationwide trend.

In many instances, patients will leave a hospital and then end up in the shelter system after they’re unable to find room at an assisted living center that can assist them with their medical needs. Peterson-Stigers said Interfaith has at least 30 people in their programs who meet this description.

In the interim, many patients still wait in the hospital. Necochea said St. Luke’s is averaging about 20 such patients across its Treasure Valley locations every month. He said some families eventually take their loved ones out of the hospital because of the high cost.

And the effect on patients mental health soon becomes evident.

“Any day a patient is in a hospital when they don’t need to be … is another day they’re not back in their community close to their families,” Necochea said.

Some families, he said, end up trying to take care of their loved ones at home, creating additional financial and time burdens.

Saint Alphonsus Health System said in a statement that it too has healthy patients staying longer than necessary, although it did not say how many there were or for how long they stayed.

A scheduled interview with a Saint Alphonsus physician was canceled by hospital leadership, because hospital officials said they couldn’t speak to such a systemwide issue, according to a spokesperson.

Necochea said the main effect isn’t on the hospital’s resources — it’s that older residents aren’t able to get the level of care they need to improve their quality of life.

“This is not sort of like a bean-counting exercise,” he said. “How do we get the best outcomes for (these patients)?”

Joni Auden Land

Idaho Statesman

Joni Auden Land covers Boise, Garden City and Ada County. Have a story suggestion or a question? Email Land at newsroom@idahostatesman.com.