Hospitals scramble to meet demand for private rooms

By Liz Kowalczyk, Globe Staff, 9/7/2003

Growing numbers of hospital patients, seeking peace, privacy, and quiet, are demanding a limited resource -- private rooms -- prompting hospitals to convert offices, doctors' sleeping quarters, and even entire buildings into single rooms.

Along with a trend toward sicker patients who need isolation for medical reasons or to prevent the spread of infection, hospital administrators said, patients are complaining about roommates. Some refuse to turn down the television, some family members talk into the wee hours, and some simply need so much medical care that nurses and doctors are at their bedside around the clock, making it hard for others to rest. Other patients say, and increasingly administrators agree, that privacy and calm will help them heal faster.

This was the reason Karen Hartford, 43, requested a private room at Brigham and Women's Hospital for a hysterectomy last year. "I wouldn't call you up if I didn't know you from a hole in the wall and say, `Let's go to Europe and have a good time.' Why would I want to be in a room with a stranger when I'm at my worst?" Hartford said. "When you're in the hospital, it's time to focus on you and your well-being. That would have been a deal-breaker for me. I probably would have canceled my surgery if I couldn't get a private room."

Boston hospitals rarely have more than 50 percent of their nonintensive care beds in private rooms, and at some hospitals like Massachusetts General Hospital, only 20 percent of the beds for adult surgery and medical patients are in singles. Since transplant patients, dying patients, and those with infectious diseases get first priority, this means patients who want more privacy often must wait to see if a room opens up during their stay.

As a result, the waiting list for private rooms at the Brigham grows to 15 to 20 patients on a very busy day, even though the hospital has a relatively large number of singles: 180 rooms with one bed plus 105 private childbirth rooms. Including intensive care units, the Brigham has a total of 719 beds.

The hospital began to expand the number of single beds by turning an old rehabilitation unit into the Shapiro Pavilion, a hotel-like private floor with its own dedicated chef, 14 private rooms, wood paneling, sweeping views of Jamaica Pond and the Northeastern University football field, and high tea for families at 4 p.m. Above each bed, nature photographs slide down to hide blood pressure monitors, oxygen, and suction equipment.

Not everyone, however, can afford the Shapiro Pavilion, which costs patients $250 to $800 out-of-pocket a night depending on room size. So the hospital last year converted offices to 10 single rooms, and will turn an on-call sleeping floor for residents into another 10 private rooms next spring. These rooms don't have a restaurant menu or 16th-floor views, but the hospital is trying to mimic the privacy of the luxury Shapiro floor at a more affordable price. Patients pay a surcharge of $137 for a private room -- over and above what their insurance pays -- because the hospital cannot earn as much revenue as if it used the space for double rooms, hospital executives said.

Mount Auburn Hospital in Cambridge, which has 56 beds in four-person rooms, Cape Cod Hospital, and Beth Israel Deaconess Medical Center are expanding their number of private rooms, while Tufts-New England Medical Center and Mass. General are not, primarily because they don't have the space. Faulkner Hospital in Boston and Lahey Clinic in Burlington have almost all singles. In Los Angeles, UCLA Medical Center is building a new hospital of just private rooms.

"If you think about it, there is no other place you would go and be expected to check in overnight with someone you don't know," said Jeanette Ives Erickson, senior vice president and chief nurse at Mass. General, who would like to have more single rooms if the hospital could find the space.

Though Massachusetts officials said they are not worried, other state regulators fear the move to single rooms is creating a two-tier system of hospital rooms, where the wealthy reside on separate floors with private rooms and the poor are placed in older doubles, one hospital executive said. Several years ago, New York State public health officials denied a request by New York Weill Cornell Medical Center to build more than 50 percent private rooms in its new hospital, said Susan Mascitelli, vice president for patient services. In the older hospital, about one in seven rooms were private. In New York City, surcharges for a private room range from $300 to $500, and Mascitelli said "they wanted a single class of care for everyone." State officials said they did not recall the reasons for the denial.

Before World War II, most hospitals were organized in 30-bed wards, in which nurses more easily could keep an eye on large numbers of patients. As Americans grew more concerned about privacy and patients rights, however, hospitals began to build four- and two-bed rooms. Now, the number of antibiotic-resistant bacterial infections among patients is growing, and preliminary studies suggest that immune systems of patients living in low-stress environments are stronger, said Gary Burk, a principal at Ratcliff, a California architecture firm that designs hospitals. Hospitals undertaking construction projects now, he said, build almost all single rooms.

Some older people who have no family, however, want a roommate for company. And the semiprivate room system is reinforced by insurers, which usually pay only for semiprivate rooms.

Assumptions about the financial advantage of double rooms, however, is changing.

Dr. Michael Karpf, director of UCLA Medical Center, which is building a $700 million, 525-bed hospital because the existing facility was damaged during the 1994 Northridge earthquake, said single rooms are more efficient. All the beds can be used, whereas hospitals sometimes cannot use both beds in a double room because a patient requires isolation, or they cannot pair a man and a woman. "We have 10 to 12 beds that can't be filled at all times," he said.

While UCLA negotiated higher rates with insurers to cover the cost of private rooms, many hospitals on the East Coast charge extra.

Jeanette Clough, president of Mount Auburn Hospital, said when patients stayed in the hospital an average of seven to eight days, an extra daily charge of $100 seemed exorbitant.

Now that the average length of stay at the hospital has dropped to 3.5 days over the last decade, however, many patients are willing to pay the surcharge for privacy.

Bill Emswiler, 44, of Walpole, would have gladly paid extra when he had surgery to remove what turned out to be a noncancerous stomach tumor at Mass. General two years ago.

His first two roommates were in and out quickly. The third, however, was paraplegic and needed 24-hour care from his family, who talked in the room late into the night. Emswiler asked for a private room -- or at least a quieter one -- but nurses said the floor was full.

"It was pretty hard to sleep, both because of my own pain and the commotion going on," said Emswiler, who was bothered enough to complain to the patient advocate after he went home. "I wasn't the most pleasant person by the end of the week."

Liz Kowalczyk can be reached at kowalczyk@globe.com.