How WA is tackling chronic hospital overcrowding

Allen Horne thought the infection on his right pinkie toe would improve. Instead, gangrene spread to the rest of his foot last December, eventually causing the 78-year-old to collapse on a downtown Seattle sidewalk.

“I tried to get up,” said the former Marine Corps air traffic controller. “I couldn’t.”

Horne was taken to Harborview Medical Center, where surgeons amputated his leg to save his life, Horne said.

As he began to recover, his Harborview team worked on a pressing question: Where would he go next?

For four months, Horne, who’s enrolled in both Medicaid and Medicare, found a new home and a place to recuperate, a skilled nursing and rehabilitation facility in Queen Anne.

He’s part of the center’s unusual partnership with Harborview that speeds and smooths the transfer from hospital to postacute care by setting up un- or underinsured patients with long-term support their insurance might not fully cover. In Horne’s case, the move connected him with teams of physical and occupational therapists, medical providers, social workers, insurance specialists and others to help him find housing after his recovery.

“That’s the secret to the whole thing,” said Horne, who lost his Skyway apartment while in the hospital. “To have people to help with the things that need to be done, so you can just keep on getting better.”

On any given day in Washington, state estimates show nearly 850 patients are medically ready for discharge, but myriad barriers - such as staff shortages at long-term care facilities, lack of insurance and low Medicaid and Medicare reimbursement - keep them in the hospital. The consequences are significant: the emotional and physical toll patients face while living in the hospital; the delay in getting other acute patients into those much-needed beds; and the enormous expense hospitals incur when housing someone for weeks to months, or longer.

“It’s not because of anything the patient is doing,” said Zosia Stanley, senior vice president and deputy general counsel of the Washington State Hospital Association. “It’s that the system doesn’t have the capacity for some reason, or has a barrier to getting that person into their next care setting.”

In Washington, a solution is taking shape, though if and how soon it could reach patients statewide is still up in the air.

State health leaders have been trying to understand and untangle the problem of delayed discharge for over a decade, work that recently culminated in a new pilot program. The pilot, based on the Harborview model, is built around better coordination among often-siloed medical, behavioral health, social service and long-term care agencies, while also paying for additional care.

The state allocated $26 million for the pilot in 2023. In return, the savings were considerable - about $28,000 per patient, or almost $14 million total, according to a January report that summarized the program’s results.

“Most of the time, it does come down to cost,” said Erin Doss, administrator of Queen Anne Healthcare, who coordinates with Harborview and helped shepherd the new pilot into the facility. “Almost anything can be overcome with a little bit of extra revenue, you know?”

At Queen Anne Healthcare, one of seven long-term care centers in the pilot, the extra dollars allowed the facility to buy medical equipment patients needed immediately, rather than face lengthy prior authorization delays from insurers. The funds also helped the facility increase staffing, buy expensive medication and get reimbursed for other care patients might need, Doss said.

Otherwise, skilled nursing and long-term care facilities often turn un- or underinsured patients away, she said.

The model allows a “way for us to afford to take care of people,” Doss said.

The January report found the pilot decreased median hospital length-of-stay from 28 to 11 days, and skilled nursing facility length-of-stay from 77 to 19 days.

The program also reported 37% lower odds of being readmitted to the hospital within 30 days, compared to similar Medicaid populations, while also expanding access to long-term support services and showing high patient satisfaction.

Janice Ingham, a Harborview nurse practitioner who, as part of the hospital’s program, treats patients at Queen Anne Healthcare, said she was thrilled to see the positive results. To her, the additional community supports baked into the pilot, like having more social workers and specialists from the state Department of Social and Health Services, made all the difference.

“That got people out the door sooner, without a doubt,” Ingham said. “There was nothing different that I did medically.”

‘A massive shift’

For years before the state’s discharge pilot launched, Harborview Medical Center had been experimenting with its own project.

Through what the hospital calls its bed readiness program, Harborview leases about 100 total beds at two skilled nursing facilities - Queen Anne Healthcare and Seattle Medical Post Acute Care - so it has a place to send certain patients once they’ve recovered from their immediate injuries or illnesses.

Since 2017, the goal has been to accommodate patients who no longer needed hospital-level care but still required some type of support. It was primarily set up for patients who were uninsured, underinsured or with Medicaid or Medicare plans.

The public county hospital pays roughly $40 million a year to care for these patients, about two-thirds of whom are covered by Medicaid, according to UW Medicine spokesperson Susan Gregg.

In 2023, the Legislature approved an expansion of Harborview’s model, as well as a task force to oversee the pilot.

The following year, the statewide effort began at Harborview and Queen Anne Healthcare, later broadening to hospital systems and long-term care centers in Vancouver, Tacoma, Spokane and Everett.

The pilot sites included PeaceHealth, Virginia Mason Franciscan Health, MultiCare and Providence Regional Medical Center, as well as Lacamas Creek Post Acute, Bridge Crest Post Acute, Avamere at Pacific Ridge, Orchard Park Care Center, Avalon Northpointe, Avalon Tacoma and Everett Transitional Care Services.

With the statewide growth of the model came more funding and new resources, including hospital-based and community social workers, rehabilitation medicine providers, and outpatient mental health and substance-use support, said Bianca Caballero, who runs Harborview’s bed readiness program.

“We knew what it took to take these complex patients and try to get them out into the community,” Caballero said. “But once we added all of those resources, we were able to do it so much better and so much faster.”

Each site was given 30 slots, caring for nearly 500 patients total between April 2024 and June 2025, when the pilot wrapped up.

In January, the task force sent results to Gov. Bob Ferguson and several state Senate and House committees.

“It was really a massive shift,” said Madeline Grant, Harborview’s chief administrative officer and who sits on the task force. “We’ve demonstrated through this pilot a workable model of care that’s shown benefits.”

A place to land

At Queen Anne Healthcare, Horne was diligent in his rehab.

He started most mornings in the physical therapy gym, exercising on a NuStep recumbent cross trainer, lifting weights and working with therapists. He learned to get in and out of a wheelchair deftly and move around with a walker, often making his way around the 120-bed facility on his own.

“Worry doesn’t get you nothing but more worry,” Horne said. “Why not keep it positive?”

Jen Newman, the facility’s rehabilitation director and a physical therapist, marveled at Horne’s progress and expressed relief at Harborview’s bed readiness program for getting him and other patients into Queen Anne Healthcare so quickly.

This month, Horne moved to an adult family home.

Another Queen Anne Healthcare resident has lived there for almost a year, after his trailer caught fire and seared his body with extreme burns that would require long-term healing and rehab. He was taken to Harborview, where - because he’s undocumented and didn’t have health insurance - he became a candidate for the hospital’s bed readiness program.

After recovering in the burn unit for a few months, he was medically ready to be discharged to Queen Anne, where he could focus on physical therapy and daily exercise.

The program “offers the ability to provide continued care and a safe discharge,” Newman said. “It also takes away the fear of getting cut off from insurance.”

Now that the statewide pilot has wrapped up, the task force plans to iron out details about how to expand the program throughout Washington, including figuring out how to transfer the system into the state’s Medicaid structure and boost reimbursement for care, said Grant, Harborview’s chief administrative officer. That process will likely take a few years, she said.

“It has been, at times, rocky. When we started, everyone was doing their own thing,” Grant said. “And then there was some trust built, and it got to a place where things really gelled and folks were working together. And that was really rewarding to see.”

While the pilot drew from the state general fund to cover care, a permanent program would ideally be funded by federal Medicaid money, Grant said.

Although the pilot has ended, Harborview is still running its bed readiness program and continues to lease 70 beds at Queen Anne Healthcare. Some aspects of the pilot have remained, like working with social workers from DSHS, who have been integral in transitioning patients, Caballero said.

The efforts have helped manage Harborview’s capacity, but bed space can ebb and flow quickly, she said.

And when the delicate balance of patient beds collapses, it’s not only those who can’t get discharged who face consequences.

“Harborview is a trauma center for all of us,” said Doss, at Queen Anne Healthcare. “If they can’t see patients because all their beds are full, they have to divert away to other hospitals. There’s a need to make sure those beds are available.

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This story was originally published May 21, 2026 at 6:44 AM.