Finding good help in health care continues to be a tough chore

It may not be the states’ responsibility to educate and produce workers, but it ultimately does fall into their laps. A continually booming economy has increasingly taken potential health care workers out of the market place, leaving a vacuum that seems, and often is, larger every month.

An annual turnover rate of between 40% and 100% dogs the health care industry. Facilities have had to close due to the inability to meet the need for labor. According to the School of Public Health in Albany, NY, shortages exist for registered nurses, home health aides, nursing home aides, information system specialists, pharmacists, dentists, and mental health workers.

That’s not breaking news to health care administrators who have to fill these positions. But what is news are the ways states have positioned themselves in finding, training, and retaining these workers. At the recent National Academy for State Health Policy conference in Bloomington, MN, several groups gathered to hash out the problem and trade ideas that could alleviate the burden.

"The supply of RNs will continue to drop," said Edward Salsberg, director of the Center for Health Workforce Studies, School of Public Health, State University of New York in Rensselaer. "In New York, nursing school applications have dropped rapidly in the past few years. Is this a short-term phenomenon due to a healthy economy? Structure is the problem, and no, it’s not a temporary shortage."

For Mr. Salsberg, the picture comes into focus with basic economic theory: Demand for the workers is increasing faster than the supply. And he added that the supply is decreasing.

In many of the states, the universities are usually the major producers of RNs, Mr. Salsberg said, and it is difficult for the states to do anything about the structure of the jobs, such as working conditions, without being accused of meddling in the workplace. At least one-half of the states have commissions and task forces looking at those issues, he said.

"If you don’t restructure your jobs, you’re not addressing the core problem," Mr. Salsberg added, referring mainly to pay issues.

Recent immigrants to the United States could temporarily fill the lower level health care jobs, he said, but that is not a good source of labor for the long term.

Improvements states should make on the supply side, according to Mr. Salsberg, include changing education strategies by increasing mandates, funding, and directives for state universities and colleges; increasing grants to private and public institutions; and increasing scholarships. Also, increasing wages supported by Medicaid reimbursement policies is crucial, he said, plus the targeted increases must be tied to wages and required pass-throughs. He also suggested permitting or increasing Medicaid fees for service, and permitting or mandating private insurance coverage for workers.

According to Karen Hicks, director of the Office of the Commissioner at the New Hampshire Department of Health and Human Services in Concord, "I used to think this is nothing a good recession won’t cure. But I don’t think that anymore."

Improving upon the quality of care patients receive cannot come to pass until the quality of the work force is improved. Ms. Hicks said there is 75% to 85% annual turnover in the home health sector and 80% to 90% annual turnover for nursing homes. She said the workers that leave those jobs are the least trained, lowest paid employees in the health care system, and there is inadequate training, a lack of benefits, a high risk of injury, and poor management and supervision.

"It is stressful to provide the type of care they provide," Ms. Hicks said, noting that the work done by those workers is very intimate and takes an emotional toll. The policy responses in New Hampshire to this crisis have been to focus on making those jobs better jobs. "The most common state response is to raise wages, about $1 an hour. People who do this kind of work want to do it. It’s more satisfying than working at Target or McDonald’s," she said.

"We need to let workers know what assistance they are eligible for, such as health care and child care for single moms and travel expenses. We also need to develop a career lattice, not a ladder," she added. "We need to figure out a way to not top out pay at $10 per hour, and establish a credentialing system. We must change the overall image of those jobs and show appreciation and recognition by the states."