UR Medicine creates in-hospital nursing home units

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Pressed by a shortage of nursing home beds for patients ready for discharge, two of UR Medicine’s Rochester hospitals have created in-hospital virtual nursing home units.

The health system run by the University of Rochester Medical Center started to organize such units in mid-December as patient censuses rose with an onslaught of new COVID-19 cases and an ongoing shortage of registered nurses remained a stubborn problem. The new nursing home units, installed at Strong Memorial and Highland hospitals, have now been in operation for several weeks. 

Known by the acronym ALC—short for alternative level of care—the units are meant to provide care to patients who would be discharged to nursing homes as residents or for post-surgical rehabilitation. Such patients too often are stuck in hospitals because area nursing homes, which are also hobbled by staff shortages, can’t admit them fast enough.

Monroe County’s perennially over-occupied hospitals have had to cope with backlogs of such patients for decades, says UR Medicine spokesman Chip Partner, “but never at this level.”

In recognition of the nursing home bottleneck, Gov. Kathy Hochul several weeks ago arranged for medically trained National Guard troops to be dispatched to short-staffed nursing homes around the state. Twenty-six medics are deployed at Monroe Community Hospital Nursing Home. Still, the measure so far appears not to have eliminated Rochester hospitals’ backlogs.

Currently, Strong on any given day has around 40 such patients, says Karen Keady, chief nursing executive. 

“Moving those patients over to (an ALC) unit frees up acute-care beds to decompress our ED and be able to do surgeries we need to do and to do other things,” she explains. 

In an environment where RNs are in critically short supply, what the ALC units most immediately accomplish is freeing up RNs to staff acute-care beds.

Nursing home residents and rehab patients typically do not demand as much monitoring as hospitalized patients. And while virtually all direct day-to-day care in hospitals is administered by registered nurses, nursing homes typically rely on certified nursing assistants for such duties.

The ALC units are staffed like nursing homes. Patient care technicians, who already work in UR Medicine hospitals, are assuming the role CNAs play in nursing homes. 

Having such technicians provide direct care to ALC patients lets the hospitals deploy more RNs in acute-care settings, Keady says. Where previously as many as 10 RNs would have been required, a single RN licensed practical nurse can be assigned to an ALC unit as a supervisor.

When the ALCs were first put in operation last month, Keady described them as a temporary measure she hoped would be needed only for a few weeks. The area Strong converted to ALC use was planned to be put to another use and hospital officials are anxious to see that project completed.

However, RNs remain in short supply while hospitals’ patient censuses continue to climb, Partner says. And how soon the UR Medicine hospitals will be able to discontinue the new ALC units is now not clear. 

Will Astor is Rochester Beacon senior writer.

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