'Staff are burning out': How a workforce crisis is affecting healthcare in Greater Newport
Newport Daily News
NEWPORT ― The Newport County Community Healthcare Collaborative held a Zoom discussion with legislators on Tuesday, Jan. 10 to discuss policy and priorities as the healthcare industry emerges from the pandemic and manages what industry leaders are calling a workforce crisis.
Child & Family CEO Marty Sinnott, who has chaired the NCCHC board for the past year, opened the meeting by recognizing the health and human service staff in Newport and Bristol counties’ local communities heading into the third year of contending with the pandemic, saying, “…Frankly, those that are in direct service, clinical capacity, and direct capacity, I have tremendous respect and thanks for. This has been a long slog, and we have a ways to go – we’re not out of it yet.”
He pointed out the collaborative’s 13 member organizations, including Newport Hospital, Newport Mental Health, Newport Partnership for Families and PACE-RI, collectively have a “pretty large footprint” in the local community.
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Representatives of local health and human service organizations explained the industry’s three priority issues heading into 2023, while state representatives Alex Finkelman, Lauren Carson and Terri Cortvriend and state senators Dawn Euer, Lou DiPalma, Linda Ujifusa and Walter Felag attended the remote session both to hear from industry leaders and to discuss developments on the legislative end things.
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Consultant Jessica David, who has worked with the NCCHC for about a year, explained health and human service providers across Rhode Island have been experiencing great difficulty finding and retaining workers, with particular challenges for providers in Newport and on Aquidneck Island.
Greater Newport Chamber of Commerce President Erin Donovan-Boyle highlighted statewide DLT data indicating that as of September 2022, there were 4,761 healthcare jobs available in the state of Rhode Island, and only 155 people available to fill them. She noted the healthcare industry’s desperate need for workers is an outlier in what is otherwise a tight labor market.
A slide displayed during the Newport County Community Healthcare Collaborative's legislative meeting shows how the unemployment rates in Rhode Island and Greater Newport compare.
Sinnott drove home the point that many of the service providers in the NCCHC are unable to meet the increased physical and mental health needs of the individuals and families they serve because they are unable to secure staff. He and others cited insufficient state reimbursement rates as a huge obstacle to offering competitive wages and made it clear that agencies will continue to flounder and struggle to retain staff and provide effective care at the current wage point they can afford to offer.
The staffing issues are not limited to one specific role: Visiting Nurse Home & Hospice in Portsmouth needs nurses, nurse practitioners and CNAs, whereas EBCAP is in dire need of early childhood teachers and Spanish-speaking staff. Regular surveys of the NCCHC members also revealed a high need for direct care staff, administrative support positions, nurses, social workers and case managers.
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Joan Kwiatkowski of PACE-RI emphasized that NCCHC members are the “safety net providers” on Aquidneck Island, covering everything from shelters to mental health to senior care and “every hardship that you can imagine a family faces during their lifetime.”
Kwiatkowski said support from the state government for health and human service providers is lacking not only in terms of revenue, but also in terms of program design and strategic planning.
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“At this point in time, what most of us experience at the state level is that there is a lack of leadership and coordination…there’s a lot of turnover within the leadership in the state agencies…and many of the individuals who have come to work there have little to no institutional knowledge, and so while trying hard, (they) lack the knowledge and ability to move a system that’s in crisis forward and support us adequately,” Kwiatkowski said.
Speaking about gaps that exist in the state’s current efforts to provide care for senior citizens, Carson of Newport said, “The thing that really jumps out to me the most is the system’s dysfunction…my general sense is that many of these systems have grown in the state of RI over years and years, and I’m not really confident there’s been a strategic growth plan to integrate everything into a system that actually delivers.”
She is in favor of elevating the state’s Office on Aging back to a full state Department on Aging.
A broken business model: lagging reimbursement rates and uncompetitive wages
Jennifer Fairbank, CEO of Visiting Nurse Home & Hospice in Portsmouth, said it was “incredibly hard to operate these (nonprofit) businesses without state support,” and thanked DiPalma for his efforts to get the state to raise its Medicaid reimbursement rates.
Visiting Nurse Home & Hospice is located at 1184 East Main Road in Portsmouth.
DiPalma, the newly appointed chair of the Senate Finance Committee, said all 38 senators in Rhode Island’s General Assembly voted last year in favor of designing and implementing a regular reimbursement rate review, which is now in the state budget (Article 12 section 7-8) but will take some time to implement.
He later gave The Daily News an example of a reimbursement rate for dental work done at nursing homes which has not been raised since 1993, pointing out by way of analogy with the state’s lagging reimbursement rates how absurd it would be for somebody to go to a store today and try to pay the 1993 price for a loaf of bread.
Fairbank presented a graph indicating the different rates at which Medicare plans reimbursed her business for one nurse visit to a private home, with the highest reimbursement rate falling about $60 below the sum of the direct and indirect costs and the lowest over $100 below the cost.
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She called the issue “the same drum we’ve been beating over and over and over again about lack of reimbursement.” Speaking to the legislators, she said, “The majority of you are in business; you can see that this is not a sustainable model.”
Sinnot put his agreement bluntly, saying, “We’re confronted with, ‘Hey, are we able to continue doing this work?’ Because we’re not meeting our own standards, and staff are burning out.”
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Dr. Jeffrey Gaines, chief medical officer at Newport Hospital, explained, “The Medicaid coverage cliff is when beneficiaries have incomes that exceed the limit for Medicaid supplemental coverage, but don't make enough to afford private supplemental insurance.”
Dr. Jeffrey Gaines, chief medical officer, at Newport Hospital.
The combination of reduced revenue when ARPA funding is discontinued, a possible recession on the horizon, and a glut of paperwork to do for clients whose healthcare situation is changing – for instance, people losing Medicaid coverage – has an industry which is already reeling from three grueling years of navigating the challenges of the pandemic steeling itself for more hard times ahead.
However, many of Newport County’s elected officials are digging deep into a nexus of issues surrounding healthcare, including housing, workforce development, opposing the privatization of Medicare and reforming the structure of the state’s discombobulated system of disconnected agencies.
DiPalma pointed out to The Daily News that increasing the reimbursement rates and addressing the workforce crisis are crucial because when agencies like those in the NCCHC are unable to provide effective specialized care, many senior citizens in particular end up in state-funded nursing homes, which is a less desirable outcome for the citizen, costs the state more money, and is still subject to the same staffing and cost issues.