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In-house staffing agency helps blunt impact of nursing home worker shortage

New Hampshire Union Leader - 6/24/2022

Jun. 24—A shortage of nursing home workers has pushed facilities around New Hampshire to close beds and use costly staffing agencies, but an innovative staffing solution is helping limit the damage at Catholic Charities' seven nursing homes.

Already feeling a staff crunch just before the pandemic, New Hampshire Catholic Charities established an in-house staffing agency, St. Jacinta Health Care Staffing. The agency was conceived to offer the flexibility and higher pay rates that draw nurses, LNAs and other health care workers to staffing agencies, but it saves money because unlike an outside for-profit staffing agency, St. Jacinta does not take a cut.

Independent, for-profit agencies take on the costs like liability insurance and workers' compensation and tack on a profit margin. St. Jacinta does not have those costs because they are part of Catholic Charities, said Tracey Lane, the agency's executive director.

With demand high, for-profit agencies are charging huge fees, Lane said — at times charging $90 or $100 per hour, with double-time for holidays and overtime, she said. And the workers themselves don't see all of that money, Lane said, because the agency pays for insurance and other costs, and then takes a cut as their profit.

The in-house staffing agency offers its workers higher pay and more flexibility — if less stability — than a full-time job at a nursing home. But because the agency doesn't take a cut as a profit, St. Jacinta can charge nursing homes less than a for-profit agency, while keeping those higher rates of pay for staff. Lane said the in-house St. Jacinta agency is growing.

"It's very challenging," Lane said. "But at the end of the day, it's working."

Small nursing home chains around the country feeling the pressure of spiraling staffing rates are starting similar in-house agencies.

In Massachusetts, the rates that health care agencies can charge are tightly regulated, with caps based on different types of jobs, varying by region. New Hampshire has no such guardrails, and Lane said she thinks staffing agencies take advantage of nursing homes' conundrum.

"It's gotten completely out of control," Lane said.

For a long time, Lane said, people accepted that nursing home staff weren't paid well, but she said that's changing as workers abandon the industry, leaving facilities in fierce competition with each other and with staffing agencies for the remaining licensed nursing assistants, nurses and other staffers.

"New Hampshire does not pay well for health care. Or they didn't," Lane said. "They have to now."

Nursing homes have turned to staffing agencies more often than ever this year, providers and industry advocates say, costing even small facilities tens of thousands of dollars a month.

But because Catholic Charities nursing homes have been able to lean on St. Jacinta, they are facing somewhat less pressure, said Rachel Lentine, administrator of the Mt. Carmel Nursing Home in Manchester.

"We have to rely on outside agencies, which can be costly," she said. But she said temporary and per diem staff hired through St. Jacinta have helped, and beyond just saving money.

Lentine said she finds St. Jacinta staffers have more commitment to Mt. Carmel, even if they are hired on a per-diem basis. Residents have a bit more stability, Lentine said, and she thinks it makes a more cohesive workplace culture.

Even with workers from St. Jacinta and outside agencies, Lentine said, staffing is still a struggle, which has led Mt. Carmel to close beds. The home has been down to an average of about 91 patients at a time in 2022, compared to 103 in 2021, she said — and the facility is licensed for 120.

"We ethically can't just fill the beds and not have the people to take care of them," Lentine said. "Overall, obviously, we are taking a hit."

Brendan Williams, president of the New Hampshire Health Care Association, a trade group for nursing homes, said this has become all too common at New Hampshire nursing homes.

"Facilities are losing fantastical sums of money right now due to the twin pressures of staffing costs and lowered occupancy — two things that are inextricably related," Williams wrote in an email. "If you cannot staff, you cannot build occupancy. If you don't have a healthy occupancy, you can't afford to staff up."

Lentine said the St. Jacinta staff are helping blunt the impact, but the facility is still hurting.

"You cut the expenses to try to make it work, but there's only so much you can do," Lentine said.


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