LegalEase: Getting to the root of the staffing shortage problem
March 1, 2002
LegalEase: Getting to the root of the staffing shortage problem
By Elizabeth E. Hogue, Esq.
Burtonsville, MD
Agency managers diligently are trying to work the kinks out of the prospective payment system (PPS). After some of the current difficulties providers are encountering during early implementation of PPS are resolved, it appears that the industry may stabilize.
As providers look forward to a less difficult environment in which to conduct business that will allow time for diversification and other endeavors crucial to the future of home care, the home care industry may face a barrier to continued growth and development in the form of staff shortages. Specifically, lack of staff to provide services to all patients who are appropriate for home care may slow the development of the strong home care industry that many providers envision.
There is a great deal of speculation about why agencies are experiencing staff shortages, especially with respect to RNs and home health aides. Some managers blame implementation of the interim payment system (IPS) and resulting reductions in the numbers of visits home care agencies can make. Staff were laid off and now may be reluctant to return to a segment of the health care industry that they view as volatile and uncertain. Others point to the increased paperwork needed to complete the Outcome and Assessment Information Set requirements as the reason why agencies may have difficulty hiring necessary staff.
But it appears that there may be something more fundamental that accounts, at least in part, for the lack of availability of staff. Specifically, many nurses have stated that they were taught in nursing school that their only job was to take care of people. The costs of care provided, levels of reimbursement, and availability of reimbursement to cover services rendered were issues that nurses were taught did not require their involvement. In other words, nurses were taught to "think" only with their hearts when providing care to patients.
The idea that nurses’ only job were to care for patients who need their help was reinforced by the cost-based reimbursement system of the Medicare Home Health Benefit that was in effect prior to passage of the Balanced Budget Act of 1997 and implementation of IPS and PPS. That is, agencies were rewarded under cost-based reimbursement for serving as many patients as possible and for making as many visits as possible to their patients. Under this reimbursement system, nurses could do exactly what they were trained to do in nursing school — take care of patients without regard to cost.
In view that nurses are the gatekeepers of the Medicare Home Care Benefit, implementation of IPS and PPS required a fundamental shift in the focus of home care RNs. Specifically, it became clear that nurses and aides must become conscious of the costs of providing care to patient. Instead of focusing solely on quality of care, field staff must learn how to provide quality, cost-effective care. In other words, they must use case management skills more intensively than ever.
This new focus for home care staff is inconsistent with the reason many nurses chose their profession and what they learned in their professional training. The need to focus on the costs of care, in addition to quality, is unacceptable to many nurses. In fact, this shift in thinking is so difficult for some staff that they will not be able to accomplish it. When combined with some of the other reasons mentioned above, nurses may conclude that they no longer wish to work in home care.
This point of view is understandable and deserves our support. We are asking nurses to fundamentally change their perspective with regard to their profession. Previously, home care nurses could say: "Give us your tired and poor, those yearning to be cared for and whatever the problem is, we will fix it. Had a dysfunctional family for 30 years? Don’t worry. We will call in a social worker, and in three short visits, we will solve the problem." The ability to meet the needs of patients without regard to cost and other factors consistent with many nurses’ view of their profession made it relatively easy to work in the home care industry.
Now, under PPS, nurses are being asked to meet different goals: to provide quality, cost- effective care. At least initially, these two goals seem inconsistent to many nurses. Concerns about costs seem to get in the way to providing quality of care.
On the contrary, the goal for nurses under PPS must be to gain an understanding that quality of care and cost-effectiveness are consistent with each other. Agencies can provide care to patients that meets both of these goals. Nurses must now think with both their heads and their hearts.
Managers need to hear these and other concerns from staff and work to resolve them to solve staffing difficulties. A useful practical strategy may be to establish a policy and procedure that requires staff who wish to resign to meet with the administrator of the agency prior to terminating their relationship with the agency. When managers can be responsive to professional and other concerns, they are likely to make some inroads in reducing the transient nature of staffing and home care. Retention of existing staff will help to relieve staffing difficulties.
Lack of staffing presents new challenges for home care providers. As nurses learn to use both their heads and their hearts, as opposed to only their hearts, support for staff in the face of fundamental change will help agencies meet this challenge.
[Elizabeth Hogue lives and works in Burtonsville, MD. A complete list of her publications is available. Telephone (301) 421-0143 or fax requests to (301) 421-1699.]
Conference replays offer educational opportunity
Have you missed one of American Health Consultants’ recent audio conferences? If so, two upcoming conference replays offer another opportunity to take advantage of excellent continuing education opportunities for your entire facility.
Disaster Response at Ground Zero: How NYU Downtown Hospital Handled Mass Casualties With All Systems Down, originally held Jan. 10, takes participants to the heart of the World Trade Center disaster on Sept. 11.
Just a few blocks away from the crash site, NYU Downtown was cut off from crucial lifesaving supplies and power, even as hundreds of injured came through the emergency department doors. HazMat teams on the roof of the hospital had to vacuum all of the debris out of air ducts to maintain air quality and keep generators running. Physicians and nurses had to balance urgent care with proper documentation.
Learn how to prepare your facility for the unthinkable. The replay will be available from 8:30 a.m. on Tuesday, April 16, until 5:30 p.m. on Wednesday, April 17. Current AHC subscribers pay $249, which includes free CME and CE credit. The cost is $299 for nonsubscribers.
On April 23 and 24, What to Say When Something Goes Wrong: Do the Right Thing When Trouble Strikes also will be available for replay. This successful audio conference covers the major fear factors clinicians experience when confronting issues of medical disclosure. Learn benefits for both patient and provider, as well as the risks of litigation and how to avoid costly legal battles. Free CE for your entire facility is included in the $249 fee for AHC subscribers.
To register for either one of these replays, contact American Health Consultants’ customer service department at (800) 688-2421. Customer service representatives will provide you with all of the necessary information on dial-in procedures and how to download conference handouts and material on line.
Correction
The Home Health Business Quarterly supplement in the January 2002 issue of Hospital Home Health, incorrectly reported that New York Health Care (NYHC) in Brooklyn, NY, had completed a deal to buy the Bio Balance Corp. The purchase of Bio Balance by NYHC is not yet complete.
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