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The nation’s current nursing shortage has spread to some home care agencies, which already are coping with a multitude of other staffing problems including finding qualified home health aides, psychiatric and IV nurses and, even for some agencies, pharmacists.
The National Association for Home Care (NAHC) and the American Hospital Association (AHA), both of Washington, DC, predict the health care staffing crisis will worsen in coming decades as baby boomers, who comprise most of the current nursing supply, age. It will be a double-edged sword because the supply of nurses and other health care professionals may decline as the need for health care services increases.
"Before, there was a trend where multigenerations of people worked for the same hospital, and that’s very different now," says Rick Wade, senior vice president of the AHA. "Opportunities for women have exploded."
While home care agencies now may have an adequate supply of therapists, there are increasing problems with recruiting home health aides, says Mary St. Pierre, RN, BSN, vice president of regulatory affairs for NAHC.
"Aides are finding other sources of work in areas where they get better benefits, better pay, and don’t have to have a mode of transportation," St. Pierre notes.
Combined with a nursing shortage that will only grow worse in coming decades, this is bad news for the aging baby boom generation.
"I’m not only concerned about what we need to do on a daily basis to keep operations flowing and growing, but I’m concerned as a baby boomer about who is going to care for me when I retire and need more intensive health care," says Greg Solecki, vice president for home health care with the Henry Ford Health System in Detroit.
"My fear is there will be even fewer providers than there are today because the population behind the baby boomers is much smaller and is not looking at health care as a desirable profession," Solecki adds.
Henry Ford Health System’s home care agency, which serves the greater Detroit metropolitan area as well as a widespread region that includes cities along the eastern portion of the state, has continuous recruitment needs for RNs and home health aides.
"We have enough LPNs, but we need RNs, depending on which region you’re talking about," Solecki says. "Some offices don’t need nurses and others do, so we’ve decided to hire good nurses even when they don’t have vacancies at one office because they can pitch in and help another office."
Recruiting home health aides is an even greater challenge in recent years, Solecki says.
"As we faced a lot of managed care growth, we were concerned about having too many home health aides two years ago," Solecki says. However, the opposite has occurred. The city of Detroit has permitted casino gambling in recent years, and three large casinos have lured away potential home health care workers.
"The population that would have been interested in being a home health aide or working in an office position has gone to the casino where they get paid a little better and the work is sexier," Solecki says.
Despite the tight labor market, the home care agency still needs to be selective when hiring home health aides, looking for the highest-quality candidates who could be entrusted with patient care in people’s homes, Solecki adds. (See story on how Henry Ford and other home care agencies retain and recruit staff, p. 63.)
In New Orleans, the Visiting Nurse Association Inc. also has found it difficult to fill the necessary RN positions.
"When you run an ad, you get very few applicants to apply," says Katherine France, RN, MN, executive director.
Home care agencies have two recruitment disadvantages not shared by hospitals. One is that home care agencies cannot afford to offer the bonuses and certain financial incentives that hospitals use to find staff, and the second is that home care agencies need experienced nurses and typically cannot recruit from nursing schools, France notes.
"Home care nurses have to make decisions without the support that they would have in a hospital, and you can only do this after you’ve had experience on a unit, particularly a med-surg unit," France says.
At Pro-Care Home Health Services in Sacra-mento, CA, the current nursing shortage has convinced the agency’s president that it is worth the cost and effort to recruit qualified nurses from overseas.
David Dial, president and CEO, has invested a great deal of time and money into recruiting nurses from the Philippines, where it’s easier to find qualified nurses with bachelor’s or even master’s degrees.
Pro-Care has hired an immigration attorney and set up an office in the Philippines, staffed by a $250 per month full-time employee. When nurses are recruited, their relocation expenses are covered, including initial housing, applying for a work visa, and airline cost. In exchange, the nurses agree to work for at least two years for Pro-Care, Dial says.
"We’re figuring it will cost us at least $5,000 per nurse," Dial says. "That’s the direct cost per nurse, and I probably have spent $25,000 so far in going back and forth to the Philippines to set everything up." (See story on recruiting home care staff, p. 65.)
The Pacific Northwest also has been hit with a very tight supply of quality nurses, especially in specialty areas of home care, says Tom Berg, general manager of the American Home Patient, Seattle Infusion Branch. American Home Patient is primarily a respiratory and home medical equipment company with 309 sites, including more than 20 infusion facilities around the country that provide home IV therapy.
"We’re starting to go to nurses who don’t have home care experience and are mentoring them with current home health nurses to get them up to speed," Berg says.
The area also has a shortage of pharmacists and pharmacy techs, Berg adds. "We have an internship program with a pharmacist where we bring pharmacy students here, and one of those students started out as an intern and has been here for 10 years."
United Home Health Services Inc. of Canton, MI, has had a particularly hard time recruiting psychiatric nurses, says Penny Rhein, BSN, RNC, vice president of the mid-sized, hospital-affiliated agency that serves western Michigan. Rhein also is the immediate past president of the Michigan Home Health Association in Okemos.
"We have two psych nurses, but they are not full time," Rhein explains. "It’s definitely a need given the fact that you have so many of your patients that have an exacerbation of underlying psychiatric problems."
United Home Health Services has fared better in recruiting and retaining home health aides, with some employees who have been with the agency for more than 10 years, Rhein says.
That may change as the need for home health aide services increases, Rhein adds. "We’re able to give patients what they need, and oftentimes patients will want to assume their own care. But as time goes by, we anticipate we’ll probably need more home health aides."
St. Elizabeth Home Care Services in Lincoln, NE, traditionally has had more staffing problems with recruiting home health aides than with finding nurses, says Phyllis Rizzo, RN, BS, CHCE, director of home care services for the hospital-based agency.
"Home health aides are a pretty mobile group of folks, and recruitment has been a huge problem in the past," Rizzo says. "Lately, we seem to be recruiting better-caliber people, and they’re staying with us longer."
However, the nursing shortage will likely cause long-term problems for the hospital and home care agency, Rizzo adds. "That’s going to be a huge problem in coming years."
Likewise, Susan B. Allen Memorial Hospital Home Health in El Dorado, KS, has not personally experienced a nursing shortage, mostly because the agency has done a good job of retaining staff, says Melinda May, RRT, BHS, director of the agency, which serves two counties in south-central Kansas.
"We retain our nurses, and one of the biggest reasons we retain them is because we’re very flexible with staff schedules," May says. "Most of our nurses are wives or mothers, and if they need to take off time for a school program, they can do that."