A Catholic hospital system is suing patients who refused to leave its hospitals while awaiting post-acute placements, saying their refusal to be discharged amounted to trespassing.

The unusual legal move paints patients as wrongdoers as the healthcare system faces deep staffing shortages that have limited skilled nursing access and left patients boarding in hospitals from coast to coast.

To pursue its claims, Dignity Health is using a state law meant to keep trespassers from preventing access to family planning clinics. It has filed three separate suits in California, calling the patients’ resistance to discharge a “commercial blockade.”

In filings with the state Superior Court for Sacramento County, the system argues that other patients needed the hospital beds. But the targeted patients and their advocates have said state law provides them a right to be discharged to facilities that offer appropriate care at a price they can afford.

At least two of the cases stem from 2021, when hospital beds were still in steep demand due to acute COVID cases.

Patient advocates warn a win for the hospital system could lead to patient dumping or more patients being pushed into home care situations for which they are not equipped.

Tony Chicotel, senior staff attorney with the California Advocates for Nursing Home Reform, told KFF the way the courts determine these cases could be a watershed moment for healthcare access.

“If it’s a defense verdict, we’ll know our laws are somewhat protective of patients,” he said. “And if it’s a plaintiff’s verdict, patients around the state could be dumped and us advocates will have to figure out what we can talk about without getting sued.”

Nationally, hospitals have raised concern over much of the last year about their decreasing access to skilled nursing facilities as they look to refer patients. At the end of 2022, the American Hospital Association reported that the average length of stay among patients being discharged to post-acute care providers had increased nearly 24% from 2019 to 2022.

In some states, patients are waiting months for skilled beds. The California Hospital Association estimates at least 5,000 patients every day experience such hospital discharge delays, according to KFF. In Massachusetts this year, an average 563 patients monthly have been stuck in hospitals due to a lack of available beds, often leading to waits of one to six months.

That’s one reason the AHA has cautioned federal regulators against adopting a nursing home staffing mandate while hiring and capacity remain major challenges.

But Chicotel on Monday told McKnight’s Long-Term Care News that the main reason for limited access is the “reluctance of nursing homes to accept hospital patients they believe will outlast their Medicare coverage and remain in the nursing home on lower-paying Medicaid.”

“Many nursing homes are also reluctant to take anyone with behavioral issues for fear they will drive up labor costs,” he added. “Nursing home census is still down from pre-pandemic levels so I don’t think the logjam is due to lack of post-acute options or capacity — I think it is mostly due to a system that responds to profit incentives.  The residents that drive the highest profit margins will be accepted, the residents that generate smaller marginal profits often won’t be.”

Dignity, a nonprofit, is going after its former patients for refusing to vacate hospital beds because the system said healthcare providers had deemed each medically and legally ready to go home or to another facility. Also targeted in the case are advocates who advised the patients on their best course of action for further care.

Dignity did not immediately respond to McKnight’s request for comment, but a spokesperson told KFF the system doesn’t comment on pending litigation.

In at least two of the cases, Dignity had said patients were ready to go home, but the patient or their family wanted access to skilled nursing as a precursor to a move to an assisted living facility. The state Medicaid system issues waivers for patients to have assisted living covered, but patients must come directly from a hospital or nursing home. A discharge home would have eliminated potential coverage.

In one of those cases, Dignity eventually moved the patient to one of its own skilled nursing facilities, KFF reported. The patient, her family and their paid advocate are all named as defendants in one case.

“A ruling for the plaintiffs would certainly cause a lot of deliberation among patient advocates and would have us questioning our standard advice which, among other things, usually includes a recommendation to stay put until a safe and appropriate discharge plan is in place,” Chicotel said. “We get calls about unsafe and inappropriate discharges with some frequency. … Maybe we would have to update our fact sheet with a warning that patients could be sued if they overstay their welcome.”