The lack of staff means Kitsap residents have few preventive care options, putting additional pressure on the emergency department at St. Michael. Last year the county had about half as many primary care providers per capita than Washington at-large, according to the Washington Health Care Research Center.
“We know that this health care system is strained and depleted,” Dr. Gib Morrow, Kitsap’s top public health official, said at a December meeting of the Kitsap Public Health Board meeting. “We also know when access to our healthcare system is impaired inequities increase and outcomes suffer.”
The shortage of preventive care options means patients often end up at St. Michael’s emergency department with low acuity needs. In 2022, St. Michael reported fewer than half of patients in the ER needed emergent medical care.
Miranda Burger, a program manager for Olympic Community Health, a state-funded agency that bridges health care gaps in the Olympic Region, said high emergency department use is a problem across all four ERs in Kitsap, Jefferson and Clallam counties. St. Michael has one of the highest emergency room utilization rates in the state, she said.
“It’s really common for patients to wait extended periods of time to get in and be seen by a provider,” she said. “It’s not uncommon for an individual to present at the emergency department in hopes of being seen.”
Limited options in region
Burger authored the 2023 Connecting Community Members to Care report, which looked at ways to preserve emergency services and reduce costs of care across the Olympic region. In it, hospitals say more aging residents come in with needs better addressed outside the ER with appropriate support.
Many of these services are limited in Kitsap. Public insurance like Medicare or the Navy’s Tricare often do not fully cover them. This can make it difficult for hospitals to discharge elderly patients. There is often not a safe place to send someone who no longer needs medical care, but lacks housing or is unable to live independently at their current residence.
“Things like in-home caregiving, assisted living or skilled nursing facilities are all things that we don’t have a lot of here locally,” Burger said.
For VMFH, much of the focus in recent years has been on building up their workforce, expanding access to preventative care and reducing dependence on their emergency department.
Staffing in particular is going to continue to be a challenge as the population ages, St. Michael President Chad Melton told the Kitsap Public Health District Board earlier this year.
“As we all know later in life we all need additional services,” he said. “Staffing is going to continue to be a challenge to meet that.”
New facilities coming
In an email, Melton said VMFH awarded $1.7 million to 24 nonprofits this year through its Community Health Improvement Grant funds. Those funds go toward agencies improving access to care, behavioral health and violence prevention.
They have also invested $50,000 in a medical respite facility planned for Sixth Street in Bremerton and $2.5 million to Olympic College to expand health care programs on its Poulsbo Campus.
St. Michael also hopes to expand access after opening a trio of new facilities. The hospital expects to open a 74-bed tower on its Silverdale campus, now under construction, late next year. When finished, it would give the hospital 336 acute care beds, estimated to provide a surplus for at least the next decade. A pair of hybrid emergency room/urgent care facilities in Port Orchard and in Bremerton also should open in 2025.
Staffing shortages have also subsided slightly. According to a report from St. Michael submitted to the health district earlier this year, the hospital has 344 vacant positions, down from 500. Melton said VMFH also continues to train new primary care physicians at its Family Medicine Residency Program in Bremerton. As of July of this year, 19 of the program’s 30 graduates were practicing locally.
“VMFH is looking at what groups are most vulnerable as they age,” Melton said. “We know from experience this can likely mean more acute care needs as well as ongoing management of chronic diseases and conditions.”
Conor Wilson is a Murrow News fellow, reporting for Gig Harbor Now and the Kitsap Sun, a daily newspaper based in Bremerton, through a program managed by Washington State University.
