Staffing Scramble 2022

New year ushers in new worries about staffing shortages, how the vaccine mandate could impact the situation – and some opportunities to get creative.

From court-challenged vaccine mandates to fluctuating CDC guidelines for healthcare workers exposed to COVID-19, post-acute care organizations are heading into 2022 with no relief from what has become the dilemma of the decade: an ongoing staffing shortage impacting access to care and placing health outcomes at risk.

At many agencies, fielding home health aides or scheduling skilled care visits to the home has become almost as tricky as outfitting nurses with PPE during the early weeks of the pandemic. Vacancies go unfilled. Exposure sidelines staff. Nurses asked to work extra shifts turn in resignations instead.

The worker shortage is top to bottom, for most organizations, from leadership and supervisory roles to caregivers and aides. A study conducted late in 2021 by the Home Care Association of America indicated that as many as 66 percent of its 4,000 member agencies had between 10 and 40 aide openings unfilled.

Stakeholders are responding by looking hard at caseload comparisons and staffing models. More often, they’re upping wages, offering hire-on or referral bonuses and otherwise trying to buy their way out of the current staffing predicament by spending more on labor.

“Personnel cost are the highest expense in home care, and those costs have been consistently climbing, quarter over quarter, during the pandemic,” said SimiTree Principal Rob Simione, who oversees SimiTree’s financial, clinical and operational consulting services.

Going up … and up…

Agencies are paying significantly more to recruit and retain skilled staff – as much as $6 more for skilled nursing per home visit at the end of 2021 than during the last quarter of 2020, according to the latest data tracked by The SimiTree Financial Monitor, SimiTree’s industry-leading benchmarking and data analytics tool.

The Home Care Association of America study showed that as many as 95 percent of its 4,000 member agencies had increased starting wages during the past year, and 64 percent raised wages by $1 or more per hour.

But as we head into 2022, paying higher labor costs doesn’t appear to be alleviating the worker shortage. Healthcare providers are poised for a potential worsening of the situation under a more contagious Omicron variant. Vaccine mandates further complicate the staffing outlook as agencies wrestle with complicated legal issues surrounding employee compliance.

Regulatory burnout

“Staffing was a priority issue prior to the pandemic, and COVID-19 has exacerbated what was already a challenging situation,” said SimiTree Managing Principal Eric Scharber, who oversees SimiTree’s home health and hospice niche recruiting and helps organizations nationwide strengthen their retention strategies.

“Retention is always a problem in highly skilled and regulated fields,” Scharber said. “There’s a high level of burnout, and employees expect more training, more education, more support, and more efficient technology to stay abreast of the regulatory demands placed on them. Millennials bring a generational aspect to it, expecting better overall life-work balance.”

While the COVID-19 crisis has enabled working at home and fostered a more relaxed work environment for many industries, healthcare workers have faced front-line risks. An additional stress factor has been ongoing confusion about regulatory waivers and flexibilities related to the pandemic. Many of the pandemic response regulations set out by the Centers for Medicare and Medicaid Services (CMS) were also subject to local level licensure and practice requirements that vary widely from state to state, adding to the overall confusion about what has and has not been allowed during the public health emergency.

“Staffing and scheduling problems tend to have a cyclical impact, frustrating and burning out leaders who are constantly dealing with the shortages,” Scharber said. “When you add the regulatory burden to the mix, especially under exceptionally stressful and confusing circumstances, it becomes even more challenging.”

Many agencies report growing concern about the impact of turnover and staffing issues on their ability to provide patient care. At last report, an estimated 800,000 potential patients around the country were on waiting lists for home- and community-based services.

In the 2021 Home Care Association of America study, more than half the agencies surveyed said they had turned away multiple cases in the months preceding the study because they lacked the staff to provide adequate care.

Vaccine mandates

There is unease among providers that the worker shortage could worsen in 2022 under the fallout from a federal vaccine mandate that requires the dismissal of all non-compliant workers.

A U.S. Supreme Court ruling earlier this month struck down an OSHA requirement which would have impacted all U.S. companies with 100 or more employees – but the Court upheld the Biden administration’s national vaccine mandate for all healthcare workers under employers doing business with Medicare. Home health and hospice workers at Medicare-certified agencies of any size are included in the group of healthcare workers which must be vaccinated.

“No one can be certain at this juncture how the vaccine mandate upheld by the Supreme Court will impact staffing as we move into 2022, but we are watching it closely,” Simione said.

Continuity of care

Ironically, as the staffing shortage worsens, agencies are noting growing evidence of a relationship between continuity of care and better patient outcomes.

“Consistency in nursing personnel has been linked in several studies to decreased hospitalization and emergent care as well as improved ADLs,” said SimiTree Managing Director Laura Wilson, who oversees clinical consulting services. She works with agencies on staffing, workflow and organizational structure, helping create service delivery models that keep agencies on track for efficiency and performance.

“Limiting the number of nursing personnel across a series of home visits may be ideal for improving outcomes and performance measures as well as increasing patient satisfaction,” Wilson said. “This makes it even more urgent for agencies to control caregiver turnover.”

What should agencies do?

SimiTree consultants say savvy agencies are recognizing that caregivers want to feel appreciated, be supported with adequate training and efficient tools, and enjoy being part of a culture of excellence.

“Healthcare is hard work, especially when you’re short staffed,” Wilson said. “Does your organization have fun? What do you do to thank your team and keep morale up?”

Pizza and gift cards are nice, but Wilson said personal gestures of appreciation are important, too. “How about a handwritten than-you note to the team member’s family thanking them for the time the employee spends working? Or an annual birthday card signed by the team leadership team? Do you actively seek out your field employees and ask how it’s going, what could be better or make their job easier?"

She recommends inviting team members to be part of decision making, program development and process design. “Often ‘patches’ get added after survey feedback, and pretty soon your clinical delivery process has ‘belts and suspenders.’ The system gets so bogged down, it increases the workload and drives away employees.”

There’s also room for creativity in monetary rewards, according to SimiTree consultants. A little creativity can check off more than one box. Productivity bonuses, for example, can be tied to quality scores and performance measures which will count toward an agency’s total performance score under Value-Based Purchasing. Maintaining public-facing quality scores that reflect a commitment to value will attract like-minded employees.

“Clinicians especially want to be involved with health care organizations who lead the way in providing forward-thinking, high-quality care,” Wilson said.

SimiTree can help

As the industry leader in solutions for compliance, growth, and profitability, SimiTree offers interim staffing and other talent solutions to help mitigate problems arising from staffing issues. Our stable of fully qualified candidates provide interim clinical staffing and leadership roles to keep organizations moving forward in times of transition and turnover.

We also offer proven retention strategies and development of internal leadership programs. We’ll provide a competitive analysis of your benefits and compensation to see how you measure up, or help you put together an incentive compensation plan.

Our consultants can help with service delivery models and keep your organization on track for efficiency and peak performance.

Let’s talk today about how SimiTree can help your organization become stronger and healthier overall.


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