The COVID-19 pandemic has presented state and local health leaders with an extraordinary shortage of workforce. The millions of federal aid that followed represented a tremendous opportunity to deal with it.
And now, a group of health, education, and state leaders have 107 suggestions for doing it.
Two years of work, Giving Care: A strategic plan to expand and support New Hampshire’s healthcare workforce has both immediate and long-term recommendations, from retaining staff with wellness programs and professional mentoring to persuading Medicaid, Medicare, and private insurers to expand coverage to case management and community health workers. Some recommendations require policy changes or new funding, while others require no money, but rather collaboration between stakeholders and the creation of a central repository for data on the state’s scattered workforce.
“In this state, we often approach problems in very isolated ways,” said Kim Firth, program director at Endowment for Health, which funded the project and partnered with the Community Health Institute to lead it. “We want this to be action-oriented. We don’t want this to be a shelf on a shelf. We actually have to work together to implement it ”.
Healthcare is among the largest sectors in the state, with an estimated 62,250 workers. The workforce projections show almost all growing specialties; Nursing positions alone are estimated to increase nearly 60 percent by 2030, according to the state’s Department of Occupational Safety.
The two organizations are implementing the plan silently with a broad audience in mind that includes not only hospital human resource managers and state agency heads, but also nonprofits, health care advocates and lawmakers. And they say parts of the plan, such as prioritizing employee career development and using technology to reduce workloads, are transferable to any industry.
Firth and Margaret Franckhauser of the New Hampshire Community Health Institute were encouraged by the feedback on the plan.
Franckhauser said at a recent meeting Commissioner for Health and Human Services Lori Shibinette encouraged the nearly 65 attendees to read the plan and choose three to five priorities they thought the department could fund, lead or play a role in. execution.
“He said very clearly to the group: ‘There is limited funding we have and we are interested in your ideas on where we can put some of this money,'” Franckhauser said.
The plan’s 107 strategies fall into four themes: recruiting and retaining health care workers; rethinking policies that hinder workforce development; collect and use data to guide decisions; and the creation of a public or private group to carry out the plan to ensure that it is not shelved.
It is the first that receives the most attention.
Like the rest of the plan, strategies for expanding the workforce “pipeline” range from those that are relatively easy to implement to others that require investments of one to two years.
Rather than just doing exit interviews, the plan recommends periodic retention interviews to learn what works and what needs improvement. He suggests recruiting creatively by marketing the field of health care to older workers as a “second career” and encouraging parents to promote the field among their school-age children.
More difficult to implement are recommendations such as providing more tuition assistance and livable, competitive wages.
Heather Carroll, director of advocacy for NH Alliance for Healthy Aging and among the 70 people who worked on the plan, noted that licensed nursing assistants can earn more in Maine, Massachusetts, and Vermont than the average hourly wage of $ 11.25 in New Hampshire. She also said that New Hampshire LNAs are “golden” for neighboring employers because their training allows them to administer drugs.
“During the pandemic, (other states) were willing to give living wages and transportation wages if they came to Massachusetts,” Carroll said. “When you are looking to meet your needs and are the only supplier in your home, these options become very tempting.”
Also attractive, Carroll said, is work that provides a reliable schedule rather than requiring workers to stay over the shift to cover a staff shortage, a practice not uncommon in all industries.
Low wages have decimated the direct workforce, which allows seniors and people with disabilities to receive care at home and stay out of a nursing home. Choices for Independence, a federal program that reimburses providers for such services, is a leading provider of such home care.
“CFI is a lot cheaper than putting someone in a nursing home, which relies on public dollars,” Carroll said. “So why isn’t the state investing in this?”
Other ideas include creating a central list of internships, mentoring, and field training opportunities for students, and making it quick and easy for in-state and out-of-state providers to get licensed in New Hampshire. Lindsey Courtney, who heads the state licensing office and helped create the plan, has already made it a priority.
The plan recognizes but does not seek to solve perhaps the biggest challenges facing the growth of the workforce in this state: the lack of affordable housing and childcare. He recommends that employers mitigate these barriers by providing financial assistance for both.
Will Stewart, executive director of Stay Work Play, encounters the enormity of these challenges in the nonprofit’s efforts to bring new people to the state.
“Many health care workers, especially entry-level workers, have low pay. This is not uncommon for entry-level workers in a number of sectors, ”she said. “Coupled with the high costs of housing, coupled with high student debt payments … and the fact that you will probably get paid in the car because public transportation is not what I would call robust, New Hampshire is an expensive place to live. “.
A woman’s comments stuck with him from a recent visit to the Upper Valley. “She said it’s a great place to raise a family, but it’s a terrible place to start one,” she said. “People want to live here, they want to stay or move here, but they can’t afford to do that.”
Stewart is encouraged by what he sees as an increase in momentum as he tries to address both challenges.
In previous roles, Franckhauser, who ran health care organizations prior to joining the Community Health Institute, recruited health workers by luring employees away from the competition. His thinking on this has changed and he believes that the fact that so many competing healthcare employers have contributed to the plan shows a shared understanding that workforce expansion is needed not just for their office but for the state.
“I think this process makes us all recognize that a rising tide floats all of us and elevates us all,” he said.