Hospitals across Washington state are in crisis. From Seattle to Spokane, hospitals in every community — including those I lead here in the Puget Sound region — are struggling with an unprecedented set of challenges that severely hinder our ability to care for patients. These include ongoing staffing shortages, insufficient capacity and steep financial losses made worse by the pandemic.

To say the last two years have been difficult for our hospitals and front-line caregivers would be a profound understatement. But there are actions that state policymakers can and should take to help alleviate some of the strain.

One of the most significant challenges facing hospitals is the inability to transition patients to post-acute care settings when they no longer need to be hospitalized but still need some level of care. At Providence Swedish hospitals in Greater Seattle, 17% of our beds are currently occupied by patients who are awaiting discharge to a nursing home, adult family home or rehabilitation center.

In some cases, these patients cannot be discharged to a more appropriate care setting because those facilities are struggling with their own staffing shortages and financial challenges that prevent them from taking new patients. Hospitals are not the right setting for people who need long-term care. Increased state funding and support for skilled nursing homes and assisted living facilities would help stabilize and bolster these vital care settings.

In other cases, Washington state’s guardianship mandate requires patients who cannot make decisions for themselves have a court-appointed guardian to be discharged. Even a family member such as a spouse or child must get appointed a patient’s legal guardian, a lengthy process that can take months to work through the courts. At Providence Regional Medical Center Everett, an entire unit of 130 beds is currently filled with patients whose lack of a legal guardian prevents them from being discharged to a more appropriate care setting. 

This guardianship requirement is unique to Washington state and is a major strain on the ability of hospitals to free up beds for new patients. State lawmakers could significantly reduce the stress on hospitals by allowing family members to place their loved ones in long-term care facilities without having to go to court.


When beds are not available, hospitals cannot admit new patients. As a result, patients wait in the Emergency Department for hours, and sometimes even days, until a hospital bed opens up and they can be admitted. As a result, our hospital EDs are overflowing with patients, and we are using every possible space to care for them — including hallways, conference rooms and offices. This is not how hospitals want to serve our patients, but too often these days the situation requires choosing “the least bad option” to provide care.

Unlike health insurance companies, hospitals have not profited during the pandemic. Quite the opposite. We have struggled to remain financially viable while doing everything we can to provide safe care and ensure access to patients who need our help.

As hospital leaders and caregivers, we take seriously the critical role we play in the community’s public health infrastructure. Hospitals across Washington stepped up to serve as the state’s public health system amid an unprecedented crisis, and we continue to keep our doors open to serve everyone who needs care. Every day that commitment becomes more difficult.

Hospitals in this state are at a critical juncture. The financial realities we face require making choices so that we are well positioned for the future. We need a commitment from state officials to make difficult but necessary decisions and deploy resources to help alleviate the strain and ensure we can continue to serve our communities.