As the pandemic rages on and a workforce crisis continues, nursing home advocates want Kansas lawmakers to start regulating nursing staffing agencies, saying prices are rising due to imbalances in supply and demand.
The proposal was one of three suggested to address the staffing shortage by LeadingAge Kansas lobbyist Rachel Monger at a legislative committee meeting last week.
âThe situation continues to deteriorate for adult care homes and of course for our residents,â Monger said. âAccording to our latest member survey and a recent virtual roundtable with 50 leaders of adult care homes across the state, the majority have closed entire units in their buildings and stopped taking admissions due to a serious staff shortage. “
Institutions are experiencing financial instability due to refusal of admissions, the high cost of care and soaring labor costs.
“All of these issues directly affect adult nursing home residents and their families,” she told Bob Bethell’s Joint Committee on Home and Community Services and KanCare Oversight.
LeadingAge Kansas represents 160 nonprofit and faith-based aging services statewide, providing approximately half of all senior care services in Kansas. Members serve over 25,000 elderly Kansans and employ over 20,000 people.
Most of the member institutions are located in cities of less than 4,000 inhabitants, which allows older people to stay close to their families and communities.
Monger said long-term care facilities are using up their budgets to pay recruiting agencies. She said the agencies are “destabilizing our health care system” and “draining emergency dollars” and the Medicaid program.
âTemporary help agencies are those outside companies that often recruit in these buildings and then sell their employees back to them as contractors who come into your building and fill where you need them,â Monger said.
The organization wants lawmakers to cap the pay rates of recruitment agencies, as well as other regulations.
He also wants the state to create a retention bonus program for nursing home nurses, similar to a $ 50 million program designed to help hospitals keep nurses in the midst of the COVID outbreak. 19.
What’s more, LeadingAge is urging lawmakers to re-allow temporary nurse aides during the pandemic – a rule that vanished when Republican lawmakers ended the state’s declaration of emergency over the summer.
âTemporary nurse aides are people who have not completed the 90 hour nurse aide course, who are certified, but who, in an emergency, are allowed to take an eight to 12 hour course. to follow all their basic training so that they can provide basic help in the daily life of the residents, âsaid Monger. “And this is all done under the supervision of nurses.”
Temporary nursing aides are also authorized due to an ongoing federal exemption.
âIt’s happening all over the country,â Monger said. âIt’s just not happening in Kansas because our state of emergency waiver expired this summer.
“It’s not a drastic thing that we’re asking. We’re just asking what the rest of the country is doing as well and what’s authorized by the federal government to help us get through what is really a personnel crisis for us.”
“This price increase is simply not sustainable”
Kansas advocates aren’t the only ones trying to regulate the nursing staffing industry.
Minnesota and Massachusetts are the only two states to have adopted measures, although lawmakers in other states have proposed legislation.
In October, the American Health Care Association and the National Center for Assisted Living called on the Federal Trade Commission to investigate recruitment agencies. Former Kansas Governor Mark Parkinson heads the AHCA / NCAL, which represents more than 14,000 nursing homes and long-term care facilities across the country.
“Our contractors have little choice but to pay exorbitant prices, and hope the agency doesn’t poach their staff once in the building,” Parkinson told the FTC. “It’s also important to remember that most LTC centers are paid for through Medicare and Medicaid programs – and therefore taxpayer dollars. This price hike is simply not sustainable for our providers and the current structure of the reimbursement system. “
Minnesota law caps recruitment agency fees at 150% of the going salary in each region of the state, Monger said. Recruitment agencies are also required to register with the state and be subject to surveillance.
âIt forces them to have employees instead of independent contractors so that they do all the background checks and training that they’re supposed to do,â she said.
They also need to get insurance and do “things that you hope and expect from a healthcare staffing agency,” Monger said, when current Kansas law has no such requirements.
Recruitment agencies focus on the economy
âThere is no pricing problem with recruiting agencies,â said Bob Livonius, of Livonius Consulting. “Rates are a function of supply and demand. Agencies increase rates proportionately and do not take unfair profits.”
He said he had worked in the healthcare staffing industry for 30 years and that “the ebb and flow of pay rates and billing rates have always been a function of supply and demand.” .
Instead of regulating the industry, he called for addressing the underlying shortage of nurses, which he says will continue to worsen if wages do not increase. He said Medicare and Medicaid caps for caregivers make this difficult.
He argued that government regulation would exacerbate the problem, not alleviate it.
“When states have tried to lower rates, agencies will either focus on placing people on other missions or stop serving the state altogether,” Livonius said. âNursing homes in both states with caps have been more desperate for staff than before the caps. Many facilities have had to pay even higher rates to import nurses into their market and pay for travel expenses. “
Many nurses also use recruiting agencies to accumulate overtime or to work part-time, he said.
The American Staffing Association, in written testimony, argued that price caps would reduce the supply of nurses and hurt patient outcomes.
“The shortage of nurses during the Covid-19 pandemic has led to a crisis in patient care,” wrote the association’s Toby Malara. âThe rate caps for nursing staffing agencies will make matters worse. The caps are intended to ease the pressure on the costs of hospitals and nursing homes. But they will inevitably reduce nurses’ wages, forcing many to leave the profession and exacerbating the nursing shortage at the expense of patients. “
“It shouldn’t be the status quo”
Haely Ordoyne represents directors and operators of care facilities as President of the Kansas Adult Care Executives Association.
âWe have full-time staff leaving us to go to work in full-time agencies,â Ordoyne said, noting that more than 90% of its members have reported the same during the pandemic.
She testified that staffing agencies charge, on average, between 200% and 246% more for a worker than what establishments typically pay their staff. An RN, for example, has an average hourly rate of $ 25. Recruitment agencies charge $ 60, although not all of this goes to the worker.
She suggested legislation capping staffing agency rates at 150% of typical salary.
Tony Johnson, COO of Recover-Care Healthcare and representative for the Kansas Health Care Association, said recruiting agencies are “offloading” workers from facilities.
âThere is a distinct possibility of access to care issues by closing facilities due to financial hardship, especially in rural communities,â he said.
Dawn Veh, executive director of Mennonite Friendship Communities in South Hutchinson, said the high cost of staffing agencies will force providers to cut back on the number of people they serve. She testified that agency staff provide poorer quality care, in part because they cannot provide the same level of individualized care to patients as permanent staff, especially to patients with dementia.
Agency staff also tend to have less training, are unreliable, go to higher paying gigs, and do not always undergo extensive background checks.
âWe understand that agency staff may be needed for emergencies, but it shouldn’t be the status quo to provide care,â she said.