Foundation Releases 2020 Barriers to Care Report

Ideally, any person needing health care should receive it in the setting most appropriate to meeting their individual needs. Unfortunately, in New Hampshire, there are many patients who no longer require acute care in a hospital setting and who are medically cleared for discharge but who are unable to leave. The delay in discharges is due to a variety of issues, which are often complex barriers to care. These delays can have a profound effect on patients, along with their families, caregivers, and health providers. This report represents the 4th time data has been collected statewide to highlight the ongoing issues confronting New Hampshire’s healthcare systems. Previous reports were published in 2015, 2016 and 2017.
Although the data and analysis in the body of this report reflect data pre-COVID-19, it is imperative to acknowledge the additional challenges and barriers to discharge that have arisen since March 2020. During this outbreak there have been significant impacts to the ability of patients to move appropriately along the continuum of care. This study offers some insights to these new barriers to discharge, although it must be acknowledged that the listing of all possible extenuating factors remains incomplete.
This report provides a snapshot of the barriers to care preventing timely hospital discharge experienced by patients in all 26 acute care hospitals and 1 specialty hospital in New Hampshire between August 1 and October 31, 2019. Each one of these patient experiences contributes to a significant cumulative financial and human cost during this three-month period. Although this data pre-dates the COVID-19 public health emergency, it remains not only relevant but continues to underscore the urgency needed to address long-term as well as newly highlighted issues.

Key Findings

  • 643 individuals were delayed in discharge, 60% were aged 65 or older, 45% had Medicare as their primary insurance, and 82% were New Hampshire residents
  • 1,037 barriers to care were reported. (More than one barrier could be identified for each patient.). Barriers were divided into 5 major topic areas:
    • 38% Housing: unable to access a place to live with appropriate supportive care
    • 26% Insurance: difficulty with Medicaid application process or under-insured
    • 18% Assistance Needed: unable to access needed mental health care, transportation or specialty care
    • 10% Decision-Making: Person lacks decision-making capacity and/or needs a guardian
    • 8% Other: other barriers including history of IV drug abuse, sex offender or criminal record

On average, a person spent 17 extra days in the hospital after being medically discharged. 65 patients experienced delays > 40 days, and 18 patients had delays > 100 days, including one individual spending an additional 495 days in the hospital.

A total of 10,598 additional, medically unnecessary patient days were reported. This translates to an estimated $27,028,7221 in additional unreimbursed acute care costs for NH hospitals in this three-month period.


Download the full Barriers to Care Report