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CNA Shortage

Jennie Maas, a registered nurse at Hillview Care Center, listens to the heartbeat of resident Paul Finner. Mass, a 23-year veteran in the industry, started her career as a certified nursing assistant.

In 2018, La Crosse County paid $653,548 total in overtime to Hillview and Lakeview employees, according to data provided by the county.

Of that, $554,961 in overtime was paid to employees with “nurse” in their title; $274,643 in overtime was paid to certified nursing assistants, specifically.

Regardless of the voluntary overtime allotted, about a dozen nursing shifts remain unfilled per day in county-run facilities, said Wanda Plachecki, executive director of long-term care and residential services in La Crosse County.

The staffing problem isn’t unique to La Crosse, or its long-term care facilities. Employers all over the state are struggling to keep positions filled due to a workforce shortage.

Steve O'Malley

O’Malley

The shortage is the result of a combination of problems such as significantly low statewide unemployment and shifting demographics — the state’s population is aging, more people are predicted to enter into retirement and fewer people are predicted to enter into the workforce to replace those exiting the workforce, said Steve O’Malley, La Crosse County administrator.

Employers are unable to find qualified people to work in large numbers of positions across Wisconsin, especially in long-term care, he said.

“The issue is compounded in lower-paid positions, such as an industry like long-term care where Medicaid and Medicare from the federal government don’t adequately pay for (the) full cost of operating a large-scale nursing facility or assisted living,” O’Malley said.

In 2018, more than 90,400 Wisconsin residents lived in long-term and residential care facilities, a 23% increase over the past 15 years, according to a report on the long-term care crisis by the Wisconsin Health Care Association.

Regardless of that increase, there was a 27.1% decline in the number of first time registrants to the Wisconsin Nurse Aide Registry between 2012 and 2018, and despite that decline, the need for personal care workers is predicted to increase 26.4% by 2022.

The aging population projected for the next few decades not only means there will be fewer people in the workforce, but also there could be more individuals who need more services and specialized care, O’Malley said.

In the next 12 years, the number of Wisconsin residents age 65 and older is projected to reach more than 1.5 million, according to a study conducted by the University of Wisconsin-Madison Applied Population Laboratory.

CNA Shortage

Certified Nursing Assistant Olivia Cracker, currently studying at Viterbo University to become a registered nurse, makes a resident’s bed at Hillview Health Center. About a dozen shifts per day go unfilled at the long term care facility due to a local shortage of CNAs in the job market.

O’Malley also pointed to the pay scale for certified nursing assistants in the area as another reason for the staffing problem, as it’s more difficult to fill positions that pay between $13 an hour and $17 an hour than higher paid professional positions, O’Malley said.

If a person enters the workforce as a certified nursing assistant, it’s only a matter of time before they move on to a higher nursing position or leave the medical field for another higher-paying profession. According to the Wisconsin Health Care Association study, 67% of long-term care providers said personal caregivers left for jobs outside of health care in 2018.

La Crosse County long-term care facilities are significantly understaffed, with nearly a dozen shifts per day that go unfilled. Often, staff will work overtime to cover gaps in shifts, but overtime is not mandated for certified nursing assistants.

“It’s going to be a challenge not just in La Crosse but statewide and nationally,” O’Malley said. “Especially when the federal and state governments have not stepped up to deal with the inadequacy of Medicaid and Medicare funding for providing services.”

And the problem could affect those who aren’t on government-subsidized medical programs at the start of their care.

If a person enters long-term care with the assets to pay for private care, they’re paying for medical services at a higher rate. If they deplete those resources and enter a county-run facility, they rely on government programs like Medicaid and Medicare, which don’t pay for the full cost of care, O’Malley said.

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The Hillview and Lakeview long-term care campuses have a higher-than-average number of residents who rely on medical assistance programs, low-income residents who require specialized care and residents who have left other facilities due to behavioral problems, Plachecki said.

CNA Shortage

Nate Kalmes, a certified nursing assistant at Hillview Health Care Center, takes resident June Holy to an exercise area. La Crosse's elderly population is growing but there is a lack of staff to care for the current number of residents in county run nursing homes.

“County homes generally have a higher percentage of residents who are on Medicaid,” she said.

But, because government-subsidized medical assistance programs don’t usually pay for the full cost of care for a resident, the facility is required to use other pay sources to cover the cost of care. And due to the lower rate of medical reimbursement, the county-run facilities are unable to pay employees a competitive wage.

“I see a group of CNAs that are getting close to retirement, have made this their career, and they’re going to be leaving us” in the next five years Plachecki said. “I don’t know how we’ll replace them because we’re not finding people who are interested in caregiving as a career” due to low wages.

Plachecki said she is watching with trepidation as the number of residents who need long-term care increase, but the number of people willing to work as a care provider decrease. Hillview Health Center has 137 licensed beds in its long-term care facility but not enough employees to care for that many patients.

“We could never fill all of those beds today because we wouldn’t have the staff available to provide the care,” she said.

Currently, 40% of the staff at Hillview are direct caregivers and 58% of our staff at Lakeview are direct caregivers. Between the two campuses, they have about 200 direct caregivers.

La Crosse County Board Chair Tara Johnson

Johnson

Not every county operates a long-term care facility,. In fact, it’s increasingly unusual that a county operates a long-term care facility, said Tara Johnson, La Crosse County Board chair.

La Crosse County regularly analyzes the pros and cons and cost of running long-term care facilities. And, according to the analysis, if the county-run facilities don’t exist, the county could spend more money to send people who reside in La Crosse County to facilities in other parts of the state.

“Then, their outcomes aren’t as good because you take people away from their community of support,” Johnson said. “We have continued to make the commitment to operating Hillview and Lakeview, and that places us in competition with other nursing home providers.”

The county is trying to maintain a high-quality workforce in a competitive environment, but it is not used to increasing worker pay to meet private-sector market demands and attract the candidates needed to fill open roles. However, that could change.

The La Crosse County Board Executive Committee passed a resolution to increase pay for certified nursing assistants who are employed at county-run nursing facilities in October, and the vote is scheduled to go before the board in November.

“That’s unusual for us because we are treating this group of employees ‘differently’ (than other county workers) because we have to maintain that workforce,” Johnson said.

If approved, the new pay rate for non-licensed positions — including certified nursing assistants — will go into effect Nov. 25 and will provide a raise of 2-3% for current employees. The county board will also consider a 1.75% pay increase for all staff, starting Jan. 1, O’Malley said in an email.

“We believe the new ranges will be more attractive when hiring new staff and help us to retain current employees,” he said.


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Data, interactive and video journalist

Elizabeth Beyer is the agriculture, data, interactive, audio and video journalist with the La Crosse Tribune.

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