As state politicians look to find solutions to New Hampshire’s nursing crisis, one local health care group is not waiting around.
The Monadnock Region Healthcare Workforce Group is finding its own collaborative approaches, whether it’s with fellow health care providers or lobbying groups.
In December 2015, Cathy Gray, president and CEO of Cedarcrest Center for Children with Disabilities in Keene, invited local nursing home administrators to a meeting to compare notes on the dearth of new nursing graduates and its effects on the health care industry.
As the meeting turned into the workforce group and administrators continued to gather regularly, the effects of the nursing shortage compounded, hurting care in facilities across the state.
Fewer beds were available for patients. Delays — in treatment and in discharge times — started to increase.
“We soon realized it was a bigger issue,” Gray said. “We’ve broadened our thinking and got a better sense of the scope of the issue.”
The group’s primary aim, according to Gray: to raise awareness. Political action, she hopes, will follow.
Other groups get involved
Politicians took notice. By April, Molly Kelly, then the Democratic state senator for District 10, got involved.
She helped draw statewide health care providers to the table, swelling the ranks of the workforce group and increasing its influence, according to Gray.
Bringing as many people into the process as possible is necessary so the gravity of the problem can be seen and addressed, Kelly said.
“Some of this is created by people sitting in their silos, and not understanding that it’s all happening together,” she said. “If we don’t address this problem, then we in the community will suffer.”
Now, the group boast members big and small — from Brendan Williams, CEO of the New Hampshire Health Care Association, to Aryca Dubeil, state administrative coordinator of the American Red Cross, to administrators from area hospitals and nursing homes. Representatives from the offices U.S. Sen. Jeanne Shaheen and Rep. Ann Kuster, both New Hampshire Democrats, are also listed members. The group’s next monthly meeting is Jan. 21.
In banding together local health care facilities, the group has followed the lead of other sectors choosing to collaborate on their workforce issues rather than compete.
That approach caught the eye of Phil Suter, CEO of the Greater Keene Chamber of Commerce. Suter says he was interested in Gray’s initiative, which dovetails with many chamber initiatives in other industries.
The manufacturing sector, for instance, has had a similar advocacy group for a decade, as skilled and trained workers become harder to find.
The same factors that inhibit the other industries — low wages, high rents and high property taxes and difficulty marketing the Keene area to young people — affect the nursing workforce as well, Suter said.
Bringing the nursing sector into the fold has increased the potential for solutions and magnified the political megaphone directed at Concord, Suter said.
“I think there are signs that they’re being heard in Concord,” Suter said of Gray’s group. “And the only reason they’re getting (that attention) is because they are a collection of employers.”
Local collaborators weigh in
As coalitions form within the industry, some local stakeholders are suggesting their own fixes.
Patricia Shinn, chairwoman of the River Valley Community College nursing department, thinks she might have a temporary solution for the lack of a licensed practical nurse (LPN) program in Keene, which is causing problems for local institutions that need LPNs. River Valley closed its own LPN program during a reaccreditation effort in 2014, citing low interest.
According to Shinn, another education facility, Harmony Healthcare in Merrimack, has suggested extending its LPN program to Keene, and has asked River Valley if there are extra rooms it could rent.
But both Shinn and Eileen Duggan, director of nursing at Harmony Healthcare, cautioned that the talks are in very early stages.
“Hopefully that is something we can assist with,” Duggan, also a member of the workforce group, said.
Hospitals are also looking to help the process.
Unlike its northern affiliate, Dartmouth-Hitchcock Medical Center in Lebanon, Cheshire Medical Center/Dartmouth-Hitchcock Keene does not have an LPN training program. But it is taking steps to broaden training opportunities for recently graduated nurses interested in entering the Keene hospital’s workforce.
Last year, the hospital amended a program it runs, the New Graduate Nurse Internship Program, to accept graduates throughout the year — an increase from the previous-once-a-year entry limit. The change allows flexibility to graduates, according to Paula Hudon, director of clinical practice and education at the hospital.
The shift is necessary: As demand for recently graduated and accredited nurses has increased, the hospital has found that fewer graduates have the real-world experience needed to take on the work expected of them, Hudon said.
Help from politicians?
Meanwhile, as a new gubernatorial administration takes office, the workforce group hopes to focus its attention on legislative fixes. At the top of its wish list, said Gray, is for legislators to approve an increase in Medicaid funding, or at least an increase in the state’s reimbursement rate.
The state’s present reimbursement system often pays hospitals and care facilities less than the cost of the operation, which in turn lowers the facilities’ operating budgets and depresses salaries, Gray says. Lower salaries mean fewer nurses enticed to join, she adds.
It’s an issue some politicians are focusing on. N.H. Sen. Jeff Woodburn, D-Dalton, has called for the Legislature to increase funding for Medicaid, arguing that by not paying the money up-front, the state pays the cost of an overburdened system down the road.
“We’re being penny-wise and pound-foolish,” he said.
Woodburn has found an unlikely ally on the issue: the Business and Industry Association of New Hampshire, which has called for an increase in state funding for Medicaid, as well as increasing eligibility for the program.
Kevin Flynn, spokesman for the association, said while the association generally stands for low taxes and responsible spending, increasing Medicaid coverage is important so businesses aren’t saddled with the cost of insuring their employees themselves.
“We would like the Legislature to look at the formula to try and figure out a way that is more fair to providers so their costs for actual care are covered,” he said. “If reimbursement rates are adequate, it should put downward pressure (on health care costs).”
But the efforts to increase Medicaid funds face strong political headwinds. The issue has long been unpopular in Concord, where a vote to approve the expansion of federal Medicaid funds narrowly passed the N.H. House last spring, despite Republican objections that it would force the state into covering the costs if the federal government pulled out. Republican Gov. Chris Sununu has expressed support for Medicaid expansion, but many in the Republican-led Legislature find the option unpalatable.
In Washington, D.C., the speaker of the Republican-led House of Representatives has advocated for measures that would weaken Medicaid funding in the long term.
Against that backdrop, many say the options to boost nursing wages through state or federal funds are thin.
Maggie Hassan, D-N.H., the freshman U.S. senator — who as governor commissioned a study into the nursing workforce shortage — supported the expansion of Medicaid funding as governor and approved the bill to do so.
Asked last week about alternative plans for funding if Medicaid is scaled back, a spokesman for Hassan said the senator would focus on training.
“Senator Hassan will continue working as she did as Governor to address the health care workforce shortage,” the spokesman, Aaron Jacobs, said in an email, listing nursing workforce development programs and unspecified training efforts as among Hassan’s focuses.
Back in Keene, Gray says she’s heartened by the push from local providers and politicians to set aside competition and partisanship to find solutions. But she said the problem will be here for a while.
“There’s no quick fix — it is a true shortage with low employment,” she said. “It’s going to be a long-term solution.”
This is the fifth in a series of articles on the nursing shortage in the Monadnock Region.