Care giving is impossible without caregivers, especially those who are dedicated to serving the elderly.
Wisconsin nursing home and assisted living providers continue to struggle through a workforce shortage crisis, according to survey results released in February by a coalition of provider associations.
The Long-Term Care Workforce Crisis: A 2020 Report shows that about one in four direct caregiver positions in the state’s nursing homes and assisted living facilities are currently vacant, up from one in five two years ago.
Extent of the problem“The numbers that came out in the report seem to be startling.” said John Sauer, CEO of LeadingAge Wisconsin. “When you figure that there’s a 23% vacancy rate for caregiver positions you know that has to have an impact throughout the long-term care continuum.”
The survey found there are as many as 20,655 job openings in long-term facilities across the state (compared to 16,500 openings in a similar 2018 report). An estimated 9,700 caregivers left for jobs outside of health care in the past year.
Sauer, whose Madison-based group represents more than 500 nursing homes and assisted living facilities, said people across the state are feeling the impact of the workforce crisis.
Columbia, Dodge and Sauk counties are no exception. An internet search of area hospital websites shows an abundance of caregiver positions available at the hospitals’ long-term care facilities.
Tivoli in Portage, Hillside Manor in Beaver Dam and St. Clare Meadows Care Center in Baraboo all have employment opportunities for those interested in health care including part-time and full-time jobs for certified nursing assistants, licensed practical nurses and registered nurses.
John Vander Meer, CEO of Madison-based Wisconsin Health Care Association and Wisconsin Center for Assisted Living, said there are a variety of reasons providers are experiencing workforce shortages that limit their ability to attract new workers.
“One is a basic demographic challenge. More people are turning 65, more people are aging and the long-term care delivery system needs to respond to that growing aging population,” he said.
According to the report, the percentage of people in Wisconsin age 85 and older is projected to increase 112% in the next 20 years. The number of people diagnosed with dementia will also climb. A sizable number of these two groups are likely to need long-term care services. In addition, more than 33,880 people with intellectual/developmental disabilities and physical disabilities require some level of care or support.
Competing for workers
Vander Meer said another challenge providers face is one of Medicaid and Family Care reimbursement. Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. Each state runs different Medicaid-funded programs for different groups of people.
Family Care is Wisconsin’s Medicaid long-term care program for frail seniors and adults with physical, developmental or intellectual disabilities. People in the program receive long-term care services to help them live in their own home whenever possible.
Nearly half of the survey respondents said they couldn’t increase wages much because of inadequate reimbursements from those programs and said they were unable to compete with non-health care employers.
“If skilled nursing facilities and assisted living facilities are not provided with competitive reimbursement that allows them to provide their workers competitive wages compared to convenience stores, big-box retailers and gas stations then facilities are not going to be in a position to compete for those workers,” Vander Meer said. “I think that all of our providers want to provide high-quality care but that it is a challenge with the availability of workers in the long-term care setting.”
Long-term care providers struggle to compete with non-healthcare employers, who pay a median wage $2 per hour higher than long-term care providers. Facilities indicated in the report that 70% of the time when they advertise for a position they get no qualified applicants.
“They may not have a certification as a CNA or they may have a criminal background that prohibits them from working in the field or there are other factors that make them an unqualified candidate. I think there’s no hesitancy to come to the conclusion that we’re in a workforce crisis and we have to become very creative in how we tackle this and it has to be at all levels,” said Sauer.
State leaders have taken notice of the workforce shortage. The Legislature and Gov. Tony Evers approved the 2019-21 budget which included a continuation of the Direct Care Workforce Funding initiative as well as a Medicaid Fee for Service rate increase for long-term and residential care providers. The most recent state budget builds upon the $60.7 million increase from the 2017-19 budget to improve wages for direct care staff in long-term care to attract high-quality workers and increase care quality.
Sauer said he credits the Legislature and its Joint Committee of Finance in particular for increasing funding for personal care, for the family care program and for skilled nursing facilities.
“That was a really healthy first step but more needs to be done,” he said.
Evers established a Caregivers Task Force a year ago to address the ongoing shortage in caregivers. Sauer is part of the 29-member panel that includes legislators from both political parties.
“We’re looking at a number of things we can do to not only support paid caregivers and to address those who call long-term care their vocation, their passion, their career, but also recognizing that 80% of long-term care services are provided by family and friends informally and unpaid. The task force is sifting through a myriad of ideas — some funding, some offering supports, grant programs, respite programs, maybe tax changes that would be favorable to people who are losing time off because of needing to be a caregiver,” he said.
Providers’ coping strategiesRight now the way providers are coping is they’re denying admissions or slowing admissions and many are asking caregiving staff to pick up additional shifts or work overtime, which can lead to caregiver burnout. Thirty-three percent of survey respondents reported they were unable to admit new residents or tenants due to the inability to fill caregiver job vacancies, up from 25% in the 2018 survey.
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LeadingAge Wisconsin advises providers that are facing the workforce crisis to make sure to manage their caseloads so as not to admit more people than they have staff to care for. Helping resolve the caregiver crisis also allows providers to care for people needing services, particularly at a time when that need is increasing.
What can be doneTricia Weisnicht, administrator at Hillside Manor in Beaver Dam, said the nursing home offers a program that hires people as a certified nursing assistant student.
“Everybody is feeling the crunch and everybody is getting ready for the baby boomers. There’s some challenging numbers out there when you’re looking at the workforce and at who’s going to need care and what time frame we have in between there. There’s a lot of creative thinking going on about how we are going to meet everybody’s needs,” she said.
Weisnicht said a CNA education is needed for different positions within any health care system so it’s a good base to start.
“The program that we have allows them to get hired within the organization and allows them to get paid while they go to Moraine Park Technical College. They take the course and do their clinicals here, then they stay right here after clinicals and take their test and get hired as a CNA. It’s a great way to get paid to go to school, get a certification paid for, and then have a job on top of it. Some people don’t have the money for a class, some people don’t have the money for testing, some people just want that opportunity and this gives them the opportunity. It gives them a base pay when they start and it gives them a different pay once they pass their test.”
According to salary.com, the average annual salary for a certified nursing assistant in our region is between $24,927 and $35,122. Salary ranges can vary widely depending on experience and whether the CNA is working day, evening or weekend shifts. Typically, the cost of a nurses’ aide training course in the area varies from $300 to $500.
Participants in the program are required to work at Hillside Manor for a year. Weisnicht said the program is beneficial in educating and retaining caregivers.
“But flexibility on all sides leads to success,” she said. “We try to get them in a class that works in their home life. Some of the classes are during the day, some are in the evening. We are constantly trying to help people switch around their hours, switch around their days to accommodate school or to accommodate family.”
Randolph Health Services offers its own CNA course onsite in an effort to recruit caregivers. Becky Kremsreiter, clinical educator at RHS, said the state requires 120 hours of training to become a CNA.
“I’ve done many types of classes at different times of the day. I’m trying to aim it to work in their lifestyle and that’s been a positive experience for everyone,” she said. “The course is available to anyone interested. I’ve had students from all over — Randolph, Rio, Pardeeville, Markesan, Beaver Dam, Columbus, Cambria and Baraboo.”
Randolph Health Services has participated in the WisCaregiver Careers program that offered free CNA courses and a position at the facility.
In an effort to attract and retain more nursing home caregivers, the state Department of Health Services launched the innovative career program in 2018. DHS received federal approval to invest $2.3 million to implement WisCaregiver Careers, designed to add approximately 3,000 nurse’s aides to this high-demand field. As of this past July, more than 9,000 people have registered for the WisCaregiver Career Program. To date more than 3,000 people have enrolled in training. Due to the number of current registrants and training enrollments, both new registration and training enrollment are now closed for WisCaregiver Careers. The organization is exploring ways to extend the program and reopen registration.
“Once they start working here they end up staying because they love the residents. CNAs are very dedicated to their people, they become like family.” said Kremsreiter. “I’ve found that every place I’ve worked. That’s ultimately why people stay in nursing and stay in health care. It’s a vocation.”
The caregivers at Hillside Manor echoed those same thoughts when speaking of why they are in the nursing field.
CNA Mary McKay, who has worked in the field for 12 years, said, “It’s the residents that keep me here. They’re all pretty cool and they all have a story.”
Registered Nurse Liz Mason said, “You fall in love with the residents. It’s definitely a calling, not just a job.”
High school recruitmentStudents at Beaver Dam, Portage and Baraboo high schools, among others, can earn a certificate in the Nursing Assistant Unit. The Start College Now program allows public high school juniors and seniors who meet certain requirements to take the post-secondary course at a Wisconsin technical college.
The student does not have to pay for the course if the school board determines that it will award high school credit and it is not comparable to a course offered in the district. If approved by the school board, the student will receive both high school and post-secondary credit for a successfully completed course.
Madison College-Portage Campus Manager Linda Nellen said the college reaches out to the high schools to promote the opportunities in long-term care.
“It’s a rewarding field with opportunities for advancement. That’s what we’re trying to educate the public about,” she said. “We typically fill two classes each semester with high school students, for a total of 16.”
Nicholas Karls, director of teaching and learning with the Baraboo School District, said students in that district take the CNA course at Madison College-Reedsburg Campus.
“The program has great flexibility and gives dual credit. We feel very fortunate that our school has a health career pathway built into its structure,” he said.
Karls said Baraboo High School also offers a youth apprenticeship in bio technology and partners with local ambulance crews to provide EMT training.
“We’ll begin offering a highly sought after medical terminology course next school year for dual credit,” he said. “We’re working with our community to fill needs and at the same time putting students ahead of the game for a career in health.”
are vitalLong-term and residential care residents depend on caregivers to keep them safe and provide the care, service and support they need to thrive. Caregivers strive to treat residents with dignity and respect.
“What we’re asking caregivers to do is to follow their heart and work in a service environment,” said Sauer. “We’re trying to attract the right people to provide a high level of care and services. Frankly, not everyone is an ideal caregiver so to some extent turnover is expected as people find their niche in terms of what they love to do and what they want to do. It doesn’t always come down to reimbursement but it is undoubtedly a major factor.”
Sauer said employers in the field need to do a better job retaining staff by being good employers, offering training and shift flexibility.
“We really need to look at mentorship programs or buddy systems for job orientation to make sure that people feel really supported as they join an organization. Really we can’t say if we do this one thing it’s going to solve the crisis, we need to come together as a society and look at a broad base of changes and innovations in order to make sure we’re well positioned to serve an aging population.”
Follow Kelly Simon on Twitter @KSchmidSimon or contact her at 920-356-6757.
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