Experts say home care staffing may be a long-term problem
Joint Commission committee is taking close look at issue
The health care industry’s difficulty in recruiting all of the necessary professional staff has taken on a new sense of urgency this year as the National Association for Home Care (NAHC) and the American Hospital Association (AHA), both of Washington, DC, have brought the problem to the attention of Congress.
Both organizations contend that today’s employee shortage is different from the cyclical shortages of previous years because it’s the beginning of a long-term shortage. This problem is compounded by the demographic trend of aging baby boomers, who will use health care services in unprecedented numbers as they turn 60 and older in the coming decade. (See story on AHA and NAHC reports to Congress, p. 39.)
Home health agencies are suffering from the combination of nursing and aide shortages, says Mary St. Pierre, RN, BSN, NAHC vice president for regulatory affairs.
"Home health, I think, has always had a problem with recruiting because you have the added burdens of staff needing a car and adequate transportation," St. Pierre says. "Also, there are problems competing with salaries that hospitals are paying and the fact that home health was hit with the interim payment system [IPS]."
IPS has forced many agencies out of business and made it nearly impossible for agencies to offer competitive raises.
Nonetheless, the current nursing shortage is unlike anything else the industry has experienced, St. Pierre notes. "We’re looking at an aging work force with fewer people going into nursing and fewer young people in nursing."
Trends affect everyone
The shortage also is widespread across the health care continuum, which amplifies the problem. In the past, there might have been times when hospitals were cutting back on nurses, and home health agencies could more easily find job candidates. Also, some hospital-employed nurses are drawn to home health’s more flexible environment.
"Home health staffing has been more manageable for our institutions over time, because with home health, you can staff more to adapt to your workers’ lifestyle," says Rick Wade, AHA senior vice president. "So in terms of home health, we’ve been able to manage that a little better, but that doesn’t mean we can continue to manage it in the future."
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in Oak-brook Terrace, IL, has recognized the unfavorable trends and now is reviewing potential changes to its policies on assessing the effectiveness of staffing in health care organizations, says Maryanne Popovich, RN, MPH, executive director of the home care accreditation program.
"What we’re looking at is the enrollments in nursing schools, because that trend is what affects the future nursing employment," Popovich says. "Those enrollment trends are down."
JCAHO reviewing home care
Staffing problems may make it difficult for agencies to balance their various clinical pressures, such as maintaining quality, holding down costs, and providing as many necessary services for the community as possible.
Recognizing this juggling act, the Joint Commis-sion has begun to review its policies and standards regarding the competencies of staffing, including home care agencies. "We have always had standards that evaluate the number and competencies of staff," Popovich says. "That’s not a change. Quite honestly in home care, the issues in the past have revolved around the therapists; and in certain parts of the country, we’ve had issues with pharmacists being available."
Popovich says it’s not just a nursing shortage issue. "If you can’t service a patient, you can’t admit the patient, and maybe another organization in your county will be able to do that."
The Joint Commission is looking for indicators organizations could use to identify problems with staffing before they reach a critical stage, Popovich says.
For example, if a home health agency has a 30% turnover rate of nurses within one month, then that would indicate there is a problem, and the agency will need to conduct an investigation and perhaps make some human relations changes, she says.
Another potential clinical indicator in home care would be the time from referral to first visit by the clinician. "This may be a very good indication of the staff’s ability," she says.
Other indicators could be the numbers of visits projected as appropriate vs. the number of visits provided and the number of patients who used the on-call service or after hours system. The latter could indicate whether patients are receiving adequate regular care.
Final decision pending
Joint Commission committees have reviewed the proposals, which will be reviewed by a home health professional and technical advisory committee, and determine if the standards are acceptable, Popovich says.
If they determine the standards are acceptable, they will forward them to a standards and survey process committee that will make the final decision on whether they will become new standards. This final step possibly could take place by the end of the year.
At this point, any changes are undetermined because the committee could decide that there is no need to change what home health standards already state. "Or they could say that developing indicators is not the way to go, or maybe it should be advice and consultation," Popovich notes.
• Maryanne Popovich, RN, MPH, Executive Director of Home Care Accreditation Program, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000.
• Mary St. Pierre, RN, BSN, Vice President of Regulatory Affairs, National Association of Home Care, 228 7th St. S.E., Washington, DC 20003. Telephone: (202) 547-7424.
• Rick Wade, Senior Vice President, American Hospital Association, 325 7th St. N.W., Washington, DC 20004. Telephone: (202) 626-2284.
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