For David Ross and the 120 people waiting for beds at a Hillsboro County nursing home, employment is an urgent mathematical dilemma.
The facility’s manager, Mr. Ross, cannot hire enough nurses and LNAs at the hourly rates offered by the county. That forced him to turn to a staffing agency. Temporary agencies charge more than double their hourly wages to dispatch temporary workers to the county. Ross had to close down his 50 of the house’s 300 beds because he couldn’t afford to fill all the empty rooms.
“We couldn’t fill 100 (vacant) positions with agency staff without overburdening taxpayers,” Ross said. “Fifty beds won’t solve the waiting list, but it will definitely save 50 people.”
Before COVID-19, hospitals, nursing homes and other health care facilities typically hired temporary workers for 13-week shifts. Dependence on these workers increased dramatically in the early days of the pandemic, as nurses and LNAs retired at the same time as medical demand surged.
“This is unsustainable and we have to find a way to solve it,” said Steve Arnen, president of the New Hampshire Hospital Association, who said the cost of contract labor rose 133% from 2021 to 2022 in hospitals. reported.
Senate Bill 149, signed last week, is intended to be a step towards a solution. As other states are considering, there is no cap on how much staffing agencies can charge, but there are limits on what staffing agencies can do to control costs.
Starting in October, nurse staffing agencies will be banned from scheduling multiple shifts simultaneously for nurses and LNAs. This is a measure aimed at thwarting double-booking, which allows staffing agencies to pressure medical facilities into bidding wars.
Government agencies will no longer be able to use the presence of contagious viruses, such as COVID-19 and influenza, as a justification for increasing facility fees.
Recruitment within the facilities that hired them is prohibited, and practices such as offering referral bonuses to temporary workers are common.
The law also prohibits government agencies from staffing facilities with nurses or LNAs whose professional licenses have been suspended.
And starting January 1, nurse staffing agencies will have to register with the state’s Office of Professional Licensing and Accreditation and pay an undetermined fee. Violation of the new requirements could result in the loss of the agency’s license to operate.
However, the new law does not require staffing agencies to disclose how much they charge to medical facilities, or how much they pay to workers, as was proposed in the original bill.
Knowing the latter would give managers like Ross a better sense of how much they need to raise wages to be competitive.
The Department of Health and Human Services and staffing agencies said it would be too burdensome and costly to comply with the requirement.
Medical leaders say a compromise is better than nothing.
Tom Blonsky, president and CEO of Catholic Charities, which has more than 100 nursing facilities, said, “At least put them on our radar and other (medical facilities) have to. Just like , getting them registered as an agency is a start.” Positions open between 7 bases.
He said his organization has reduced agency labor costs from less than $3 million before the pandemic to more than $10 million. “It’s not sustainable,” says Bronsky.
The vacancy rate for nursing home nurses and assistants in the state was 40.6% in April, more than double the national average of 19%, according to AARP. Brendan Williams, president and CEO of the New Hampshire Health Care Association, which represents long-term care providers, said there would be a shortage under President Joe Biden’s proposed minimum staffing requirements for nursing homes. I fear it will get worse.
Medical leaders said existing staffing shortages were affecting residents in need of care.
Ross said the Centers for Medicare and Medicaid Services reported an average 81% occupancy rate for nursing homes in the state as of July 23, despite some having waiting lists.
Williams said he fears Biden’s proposals will push up labor costs without meeting the administration’s goal of improving the quality of care. While the Centers for Medicare and Medicaid are still reviewing the proposed rule, officials previously recommended a minimum of 4.1 hours of direct care per resident per day, a KFF standard that only one-third of nursing homes can meet. It is said that it was judged that it was not enough. January Analysis,
“Any amount of wage increases will simply charge the agency more and not provide the transparency factor that requires the government to know how much of it will be paid to workers,” Williams said. Ta. “That’s not all they charge, but it could be a little bit more than providers can afford to pay, so it will continue to be more attractive to workers going forward.”
At the Hillsboro County Nursing Home, LNAs are starting at between $19.30 and $30.17 an hour, Ross said. Staffing agencies charge the County between $38 and $65 an hour to fill these positions.
Ross said he has no way of knowing how much more agencies are paying their staff compared to the county’s wages.
Bronsky said he lost workers as soon as they started working because the agency double-booked them and sent them to facilities that paid $5 more an hour. He hopes the new law will stop such practices.
“It’s a matter of integrity. It’s important to do the right thing,” Bronsky said. “The key is not to abuse the system.”
Bronsky said the law would help contain some costs, but rising costs of contract workers could motivate facilities to rethink hiring and retention.
“How flexible is your schedule?” he said. “How creative can you be with your pay structure? Do you offer long-lasting bonuses? what are you doing?”
Senator Cindy Rosenwald, a lead proponent of the new law, said the state’s broader efforts to hire more healthcare workers, make housing more affordable and expand access to childcare services would also help. He said he hopes that
“If we use the tools we have to encourage new health care workers to stay in New Hampshire, they’ll probably like New Hampshire and put down roots here,” she says. . “But they have to be able to afford to live here.”