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NAHC, AHA draw attention to nursing crisis
Congress recently held a hearing about the current nursing shortage crisis, and members of the Senate’s Aging Subcommittee of the Health, Education, Labor, and Pensions on Health Care Workforce listened to what health industry representatives had to say.
Here are some of the highlights from testimony by the Washington, DC-based American Hospital Association (AHA) and some excerpts from a letter the National Association of Home Care (NAHC), also of Washington, DC, had written on the topic:
1. The health care work force situation is grave.
"The dramatic reductions in reimbursement for home health agencies combined with a flood of new regulatory requirements have made agencies unable to attract nursing staff with competitive wages and benefits," wrote NAHC’s Val Halamandaris.
Halamandaris noted the number of patients served by the Medicare home health benefit has dropped nearly 1 million between 1997 and 1999, and claims were reduced by 40%. The nursing shortage resulted in home care agencies having to turn away the more costly and intensive care patients, he says.
"The shortage of the available pool of nurses further exacerbates this problem for home health agencies, which are unable to provide adequate pay and benefits to attract nurses to home care," Halamandaris wrote.
This shortage comes in the backdrop of major cuts in home care staffing since 1996. Between 1996 and 1999, more than 51,000 nursing positions and more than 54,000 home health aide positions were lost, Halamandaris notes.
Numbers don’t add up
The industry now is facing a future crisis because the employment reductions in Medicare are in sharp contrast to continued growth in demand for home care personnel, Halamandaris stated. "The Bureau of Labor Statistics forecasts an 82% increase in the demand for key home health personnel for the period 1998 to 2008," he adds. "Due to the severity of payment reductions under the Balanced Budget Act, agencies increasingly are unable to offer competitive wages and benefits to attract qualified staff, and labor shortages are developing across the country."
The AHA told Congress the government and public’s demand for the highest-quality patient care at the lowest public cost has come face to face with the tightest labor market in the last 30 years.
"For example, government predictions state that the nation will need 1.7 million nurses by 2020, but just more than 600,000 will be available," says Brandon Melton, vice president for human resources at Denver-based Catholic Health Initia-tives, who spoke on behalf of the AHA Feb. 13 before the Aging Subcommittee.
Will quality suffer?
2. The shortage is threatening quality of care.
Halamandaris gives these examples of how the crisis has impacted patients:
• New Jersey’s home health aide and nursing shortage is so severe that some home health agencies were forced to refuse all new admissions for several days to a week or more due to lack of sufficient nursing staff.
• The Connecticut Colleagues in Caring Project has reported nursing vacancy rates in state hospitals have doubled in the past four years, and the number of newly licensed nurses last year declined by 25% from four years ago.
• Demand for nurses currently exceeds the supply, and this trend will worsen as the population age 85 and older doubles by the year 2025 to an anticipated 7 million. By the year 2010, the number of people who have two or more activities of daily living limitations is expected to increase from 4 million in 1990 to nearly 6 million.
3. The crisis demands immediate action.
Halamandaris offers these suggestions for solving the problem:
• Providers, nursing education institutions, and secondary schools should form partnerships to increase nursing school enrollment. This could be done through programs that forgive loans, reimburse tuition, offer staff development, and provide career ladders for unlicensed personnel.
• Media campaigns should be aimed at junior high and high school students, making them aware of health care as a potential career choice.
• The service delivery model should be transformed to a team approach to service model in which RNs are involved in all aspects of quality.
• Agencies need to use technology to streamline paperwork and to create staff models that relieve RNs of nonclinical duties and paperwork.
• Technology also should offer some solutions through use of telemedicine, improved scheduling, and education offered through Internet or telephone sessions.
Melton told Congress about innovative programs being used across the country to recruit and retain health care workers, including the following:
• A medical center in Great Bend, KS has formed an alliance with community colleges to increase enrollment in nursing schools, and the center has joined with the state board of regents to make scholarships available to nursing students who agree to service payback agreements.
• A Des Moines, IA-based medical center has offered staff flexible scheduling, premium pay and compensation, and four different weekend work packages of which the richest package offers full benefits and pay at 170% of the base pay, plus a 12% night differential.
• A hospital in Little Falls, MN, promotes health care careers in area elementary and middle schools and offers employees a bonus for referrals that result in part-time or full-time employment.
Collaboration is key
4. Long-term solutions still are needed.
Melton told Congress the solution lies in a multitiered, collaborative approach among hospitals, health care facilities, academia, and the work force.
The AHA also suggests the perception that health care providers are no longer favored employers needs to be changed. In recommendations developed by the AHA Strategic Policy Planning Committee, dated Jan. 23, AHA stated health field careers have become less popular in the past two decades due, in part, to the perception that health care is low-tech employment and health care jobs are unstable and chaotic.
Additionally, health care no longer is one of the few options available to women, and health care workers no longer have time to develop supportive relationships with patients because hospital stays are relatively short compared to previous decades.