- From the Salina Journal: Medical facilities want change – Kansas nursing homes and hospitals have relied on staffing agencies – at a high cost (Featuring Rachel Monger and member Charlotte Rathke)
October 6, 2022 | Salina Journal, The (KS) | Author/Byline: Andrew Bahl; Topeka Capital-Journal | Page: A1 | Section: News
The workforce at Kansas hospitals and nursing homes is increasingly tied to firms that aren’t regulated at the state level and are often out-of-state — and those facilities say they are fed up and want action.
Finding enough workers is a challenge for health care across the state. That is certainly true in Rush County, where Locust Grove Village, a nursing home in LaCrosse, is hanging on for dear life.
Attracting staff has been a problem for some time, administrator Charlotte Rathke said, and like many of their peers, Locust Grove Village has been forced to rely on contract workers from staffing agencies, firms that supply workers to hospitals and long-term care homes regionally and nationally on an as-needed basis.
The COVID-19 pandemic caused the cost of relying on those contract workers, however, to skyrocket.
Facilities like Locust Grove Village frequently rely heavily on residents who are on Medicaid or Medicare, limiting their ability to match higher wages elsewhere and leaving them with little choice but enlisting the outside firms to help. Now, 90% of the revenues at Locust Grove Village are going to pay staffing costs that are largely powered by agencies.
“There’s a cost that you bear as a provider that these agencies never will experience,” Rathke said.
Many hospitals and long-term care homes find themselves in a similar boat. Unable to attract staff workers, they are increasingly reliant on these outside firms to maintain a basic level of staffing — at a cost.
But there is a broad acknowledgement that the challenges facing the state’s health care workforce are multifaceted.
Many argue cracking down on staffing agencies won’t solve the entire issue.
For Adam Tebben, joining a staffing agency helped him fulfill a goal of seeing what it was like to work in a smaller Kansas hospital.
After four years of work at Wesley Medical Center in Wichita, Tebben opted last October to move to a Kansas-based agency that supports small- and medium-sized hospitals in the state.
“I think that they’ve got to cultivate a home for nurses, pay them substantially more, and figure out how they’re going to do so,” Tebben said of the challenges facing hospitals and nursing homes.
COVID-19 worsens nurse shortage, heightens costs for outside help
Traveling nurse agencies have become a target not just in Kansas but nationally, with hospitals and nursing homes, like the one in LaCrosse, arguing they have exacerbated pre-existing workforce problems.
Even before COVID-19, nurses and health care workers were in high demand. While Fiscal Year 2019 marked a five-year high for the number of nursing licenses issued, according to the Kansas Board of Nursing, vacancy rates hovered at 11%. Turnover was even higher.
The pandemic only increased these factors, with hospitals and nursing homes pushed to the breaking point. That burden fell on all staff but, particularly, nurses. As COVID-19 waxed and waned, the increasingly political nature of the virus also increased vitriol directed towards staff.
All the while, demand for staff soared, with travel agencies stepping in to fill the void. Even the state of Kansas isn’t immune to having to resort to such measures.
The Kansas Department of Aging and Disability Services reported spending over $11 million in July and August alone on workers from staffing agencies at state hospitals. In the private-sector, officials in long-term care argue the financial crunch is already having an impact on ensuring there are enough beds for aging Kansans.
Data from LeadingAge Kansas, a group representing nonprofit nursing homes in the state, said there are around 1,600 fewer beds in Kansas than there were at the start of the pandemic.
Rachel Monger, a lobbyist for LeadingAge, said this means that facilities routinely first shutter specialized units, such as those caring for individuals with dementia, because they can’t find the staff.
“What it’s doing to our communities who need the services, it is really devastating,” Monger said. “We have members who have shut down significant parts of their buildings because they can’t staff them.”
An August report from the health care jobs board Vivian Health showed wages had increased since July 2021 but showed signs of decreasing to what travel nursing firms were paying before the COVID-19 pandemic.
Staffing agencies acknowledge some bad actors exist in the industry but insist the sky-high prices are a result of rising costs across the board.
In a legislative hearing in February, Bob Livonius, a lobbyist representing the American Staffing Association, a trade group of staffing agencies, said net profits for many companies actually went down during the pandemic.
The same issues of supply and demand that have slammed nursing homes and hospitals, he said, were an issue for staffing firms as well.
“The anecdotal complaints about agency bill rates are not the whole story,” Livonius said. “The exclusive focus on rates ignores how rates are determined; specifically, the myriad costs agencies necessarily must incur to provide their services, and that they must recoup in the rates.”
Is capping nurse wages the answer to solving staffing problems?
A bill introduced in the Legislature earlier this year at the behest of a long-term care lobbying group has been touted as a potential solution.
The measure would cap the pay traveling agencies could offer, as well as increase regulatory oversight of the firms. Advocates argue it is a needed, if imperfect, way of ensuring hospitals and long-term care homes can have a chance to keep up.
Monger said they didn’t fault nurses, nurse aides and other staff who went to work for a staffing agency. But such a move, she added, leaves facilities in the position of sometimes having a worker leave, only to pay a firm a markup to bring back that same individual as a traveling nurse.
But nurses oppose any sort of cap, arguing it unfairly limits the ability for workers to earn more money.
“To put a cap on the pay is probably the most ridiculous idea that anyone would put forward,” said Kelly Sommers, president of the Kansas State Nurses Association.
Opponents say the cap will only serve to push talent out-of-state, particularly in the Kansas City metro area, where an individual could go work at a Missouri hospital with little effort. Critics also say a similar wage cap policy in Minnesota hasn’t worked at improving staffing.
Others say it will simply disincentive individuals from entering the nursing profession at a time when the number of new nurses are already beginning to dip and could set a dangerous precedent for curbing the wages of staff nurses.
“It might deter them away from even becoming a nurse at all and going into something else in health care, that they can make good money,” said Tebben, who joined a staffing agency. “I’ve seen that happen. And people kind of turn away and go to oral hygiene, kind of a different part of health care, but it pays very well and nurses are underpaid anyways.”
Many argue the reasons why a staff member might leave for a traveling firm are more complicated than simply seeking more money.
In a state like Kansas, they could be seeking more control over their hours or working conditions. Others might want the adventure and flexibility that can come with traveling and moving from facility to facility. Some, like Tebben, make the jump to fulfill a professional goal.
“If the logic is well, then these nurses will have to leave the agencies and come back to bedside care, I think they’re going to be highly mistaken,” Sommers said.
Monger acknowledged the potential to lose staff to other states but said the idea was still a worthwhile one.
“We understand that argument,” she said. “And it could be a risk. But before we introduced that we did talk to our counterparts in Minnesota, and they said ‘Yeah, it is not perfect, but it is the one way we have had to try and rein in those costs.'”
Not everyone agrees on how best to tackle staffing agency issue
Cindy Samuelson, senior vice president for member and public relations for the Kansas Hospital Association, said most of their members agreed on provisions of the bill, such as requiring staffing agencies to register in the state and implement more transparency on costs. But a wage cap was different.
“It’s nothing that we’ve really come to consensus on,” Samuelson said, adding some hospitals liked the flexibility from embracing staffing agencies while others felt they were being bled dry.
While the bill advanced out of the House Children and Seniors Committee last session and will almost certainly be re-introduced when legislators return to Topeka in January 2023, its fate is uncertain. But Rathke, the administrator at the La Crosse nursing home, said she was hoping legislators would heed the call and do something. The nursing home only uses three staffing agencies, all of which are based in Kansas, but that doesn’t stop a near-constant stream of calls from companies located further afield. Past experiences with some of those firms have left a bad taste in Rathke’s mouth. Some were slow in filling in for staff members who called in sick, others instructed their workers not to report a workplace injury. Because of limited staffing, she was already having to make decisions about who could be admitted and who could not, meaning individuals with more complex needs were often the first to be turned away. Such choices, she said, were not sustainable.
“It’s becoming unbearable,” Rathke said. “I’ve been in this business for a long time. I have a comfort of knowing what to do and how to run this organization. But I’m struggling. I don’t have a corporate structure.”
- McKnights LTC News Featured Rachel Monger in This Article: Debate over agency rate cap divides nursing factions
