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By Monica E. Oss

In the week that ended March 21, 2020, more than three million people filed for unemployment benefits as businesses continue to shut down to contain the spread of the novel coronavirus 2019 or COVID-19 (see 3.3 Million File For Unemployment Claims, Shattering Records). We’ve never seen anything like it before and it will probably get worse before it gets better.

But hidden in these numbers is the high demand for workers in the health and human service field—the essential soldiers in the “war” on the COVID-19 pandemic. During the last few years, the supply and productivity of the workforce has become one of the key strategy issues for health and human service organizations (see Workforce Shortages As A Strategy Issue). But the strain of addressing COVID-19 is adding, and will continue to add, new pressures to an already stressed labor market.

There are a few factors in play—and they vary by type of provider organization. Hospitals are swamped with critical care patients. And hospital workers in most cases are working long shifts while lacking proper protective gear. Even with the just-passed stimulus bill (see Trump To Sign $2 Trillion Coronavirus Relief Bill At 4pm), caring for these consumers will not be cost neutral. An analysis conducted by Strata Decision Technology found that regardless of a proposed 20% increase in reimbursement for COVID-19 treatment, which is part of the stimulus package being considered by Congress, health systems could lose anywhere from $1,200 to $8,000 per case depending on payer mix. That same analysis shows a worst-case scenario of losing $2,800 or up to $10,000 per case if reimbursement premiums aren’t raised (see Report: Hospitals Face Massive Losses On COVID-19 Cases Even With Proposed Increase In Federal Reimbursement).

Then there are the issues of provider organizations serving consumers in residential settings. How to find out if workers or consumers are positive for COVID-19 is a key issue. What to do with consumers who test positive is another (see Nursing Home Lockdown Creates Unique Problems For Seniors And Families and Nursing Homes Fear Accepting Patients Who May Have Coronavirus Exposure In Hospitals).

The move to services delivered by telehealth is another issue. Lots of services, but not all, can be delivered on tech-enabled platform—and not all health care professionals are proficient at delivering those services. You also have to consider that not all consumers can or will use tech-enabled services, and many provider organizations don’t have the equipment and tech infrastructure to deliver telehealth services. The combination of these factors means some consumers are having trouble accessing care, there are mounting numbers of furloughed workers, and provider organization revenue streams are pinched.

And for those services that must be delivered face-to-face, across all settings, there is the risk of infection of clinical staff. The combination of no testing and the short supply of personal protective equipment causes anxiety among those team members. James Stewart, MBA, chief executive officer of Grafton, offers one example: Home health aides are serving in-home populations that may be elderly, recovering from various health issues or both, which are huge risk factors with COVID-19. The aides go home every night knowing they have to be very careful so they don’t harm those who are in their own homes and so they don’t bring the virus to in-home consumers they serve, which could be a death sentence for an otherwise recovering patient. These aides are on the frontlines of the COVID-19 fight just as much as the nurses and aides in hospitals but get little recognition or pay.

Before COVID-19, the Department of Labor published the Fastest-Growing Professions list—16 of the 29 occupations fit squarely into the health and human services realm as shown below (see full data Department Of Labor Employment By Major Occupational Group, 2018 And Projected 2028). But, the likely salaries for the fast-growing health and human service professions – $24,000 per year for home care aides and personal care aides – are the lowest of all of these professions. A challenge for recruitment and retention.

Mr. Stewart elaborated on the problem of historically low wages for highly valuable “support occupations” that are the backbone of the care teams especially for specialty provider organizations. Direct service professionals like personal care aides “are the lifeblood of what we do in a residential and private special education school on a day to day basis,” he said. As Grafton serves people with autism, aides might have registered behavior technician certification and are trained and certified on the organization’s crisis intervention model that includes de-escalation techniques, and compassionate response to trauma. They’re expected to read, understand, and follow treatment and behavior plans with little clinical oversight. In addition, they help consumers with self-care, food prep, parent/guardian interaction, and have many other responsibilities. They earn $17.00 per hour on average.

The COVID-19 stimulus package puts wages for essential team members into perspective, Mr. Stewart said. The unemployment bill will pay people a straight $15 per hour to stay home ($600 per week at 40-hour week calculation, not taxable). “If I adjust that pay for the effect of those payroll taxes, it’s really almost a $20 per hour wage. So, in essence, if an aide in this nation can find a reason to stay home because of COVID-19 (such as childcare because schools are closed or a family member who needs assistance because he or she is shut-in due to the virus and quarantines) I can get a raise of roughly $7 per hour to stay home with my own family and not risk getting sick myself by entering the community. We simply have two of the most high-growth positions being extremely under-valued and under paid.”

And thinking beyond the pandemic response period, will these positions be attractive? The lingering fear of communicable disease (see Health Care Workers Concerned For Safety As Coronavirus Cases Rise) and low wages are not a great combination. And, other industry sectors are actively recruiting workers. Amazon announced that it is looking to hire 100,000 new warehouse and delivery workers to meet increased demands for shipments as a result of the pandemic. And, Amazon will also increase the hourly pay of workers employed in these positions by an additional $2 in the United States through April. Dave Clark, Amazon’s senior vice president of worldwide operations, said the company welcomes people laid off from other jobs “until things return to normal and their past employer is able to bring them back.” But this could become the “new normal.” Recruiting and retaining support professionals could become more difficult than ever before.

What should provider organizations do to mitigate the potential staffing shortage crisis? OPEN MINDS Senior Associate Sharon Hicks suggested ways for provider organizations to set themselves apart by highlighting opportunities for mission-driven work. Millennials and Gen Z youngsters entering the workforce are known to care about social causes. They care deeply about the issues that affect their communities and others around them. Serving our most vulnerable populations with complex and chronic health and social challenges is likely to be more appealing than working for a large corporation. The same can be said for the legion of retired health care workers who are returning to practice in the face of the pandemic (see ‘I’ve Been Missing Caring for People.’ Thousands of Retired Health Care Workers Are Volunteering to Help Areas Overwhelmed By Coronavirus). The individual stories are heartwarming. For example, Lisa Lewis, MD, owner of Sustaina Center for Women in Colorado, was able to recruit a nurse practitioner from the east coast, who accepted a significant pay cut and moved across the country for the position because of the clinic’s participation in two federally funded innovation efforts. Dr. Lewis said: “She (the nurse practitioner) took a significant pay cut to work at our office because she wants to experience this stuff. I’m now able to recruit at a higher level. We are practicing medicine in a different way and that’s appealing to a lot of clinical professionals (see SIM Practice Optimizes Staff, Prevents ER Visits, Boosts Payment).

It is too early to tell what the net effect of the pandemic will be on service delivery in health and human service organizations. What we do know is that, right now, the teams of every organization need the kind of crisis leadership that protects the workforce as much as possible – and provide the best possible organization for serving consumers in a very difficult time. For more on recruitment, retention, and overall staffing from the following articles in the OPEN MINDS industry library:

  1. The Human Factor -Strategies for Talent Management & Improved Consumer Access
  2. The Staffing Equation For Community-Based Services
  3. 12 Innovative Ideas To Improve Recruitment & Retention
  4. Workforce Shortages As A Strategy Issue
  5. Will Clinical Professional Compensation Drive Task Shifting?
  6. Building A Better Workforce: Talent Management Strategies For Recruitment, Retention, Burnout & Technology
  7. Market Intelligence Toolkit on Recruitment & Retention
  8. Maximizing Staff Recruitment Efforts
  9. How Bots Can Help You KEEP Your Staff
  10. Trends In Specialty Provider Organization Executive Compensation & Retention: The OPEN MINDS 2019 Survey

And for more, join us September 15 for the “No Place Like Home: The Benefits Of A Remote Workforce Program” with Peggy Terhune, Ph.D., president/chief operating officer, Monarch; and Joseph Naughton-Travers, EdM, senior associate, OPEN MINDS during the 2020 OPEN MINDS Executive Leadership Retreat in Gettysburg, Pennsylvania.

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