By Jessica Morris
According to a new report from the Paraprofessional Healthcare Institute, an advocacy organization for personal care aides, home health aides and nursing assistants, a caregiver shortage in the U.S. could lead to as many as 7.8 million unfilled jobs by 2026.
For the past several years, private duty nursing providers in West Virginia have struggled with having enough nurses to fill the need of the authorized hours for pediatric patients. Private duty nursing is a registered nurse (RN) or licensed practical nurse (LPN) caring for one patient in their home. Private duty nursing is face-to-face skilled nursing that is more individualized and continuous than the nursing available under home health benefit or routinely provided at a hospital or nursing facility. It is supportive to the care provided to an individual by the individual’s family, foster parents and/or delegated caregivers. This hourly care based on medical necessity requires an RN or LPN. Most of these hourly services are authorized through insurance companies, West Virginia Medicaid and/or West Virginia Medicaid manage care organizations.
Jan Williams, LPN, with in-home client Eva. Photo by Melissa Coffman.
The Recruitment Struggle
Recruitment of nurses that are willing to work for lower hourly wages is the primary challenge for private duty nursing providers. It takes a strong, independent, seasoned nurse to take on the role of a private duty nurse. Nurses are able to work in a hospital or facility and earn double if not triple the salary and benefits private duty nursing agencies are able to offer, leaving providers of this important service hindered.
Medicaid does reimburse private duty nursing services in West Virginia, but the hourly rates are lower than other states. West Virginia private duty nursing providers have not received a rate increase for more than 15 years, making it increasingly difficult to cover some areas—and impossible in others—due to lack the of nursing applicants.
Private duty nursing providers have been working on recruitment strategies to help fill these open positions. They are using online advertising on site likes Indeed, CareerBuilder and IHCcareers; social media; word of mouth; and unemployment centers to ensure they capture anyone interested in working with private duty nursing.
The Mountain State offers a variety of employment opportunities for nurses. One of the best-selling tactics for private duty nursing providers is great part-time employment. Working part-time in private duty nursing allows nurses to have the benefits and salary they seek and one-on-one patient care a day or two per week. These agencies provide great education, supportive nursing staff and technology such as simulator labs on-site. Using this technology has helped validate long-term care nurses so they can transition to one-on-one care. This is a rewarding position for nurses to make a difference in patients’ lives while keeping them at home with their families.
The Impact on Private Duty Patients and Community
The private nursing shortage means pediatric patients and families are going without supportive care. The skilled medical care falls onto the patients’ families, foster families and/or caregivers when nursing staff is not available. This becomes exhausting and increases the risk of medication and treatment errors, which can result in hospitalization or worse for these fragile pediatric patients. if private duty nursing providers have employees call off, many times they cannot find a replacement. This results in the families or caregivers missing work or school or being forced to function despite a lack of sleep.
Lisa Mitchell, RN, and Sara Guthrie, LPN, in the simulator lab. Photo by Jessica Morris.
Accepting new patients for private duty nursing has become a waiting game. For example, case managers at regional hospitals will contact providers to see if they have nursing available in the location where a specific child lives. This could be an opportunity for the child to go home for the first time ever due to their diagnosis and/or medical needs, but many pediatric patients spend years in the hospital before going home with private duty nursing services. Providers review what they have available, but many times they must decline referrals due to shortages.
Providers are changing their business plans to focus on profitable lines that can be successfully serviced. The nationwide nursing shortage is hitting West Virginia hard. There needs to be a stronger focus at the state level to look at reimbursement rates to keep these patients in their home environment. Ultimately, private duty nursing is cheaper than alternatives that include institutionalization out of state or long-term hospitalization.
About the Author
Jessica Morris is an administrator for Interim Healthcare of Morgantown and Bridgeport. Interim Healthcare provides a variety of medical and non-medical home care services, including private duty nursing services, personal care and support services, intermittent visits and staffing. Morris has been with Interim Healthcare for 20 years.
2 Comments
Great article. Hopefully the West Virginia legislature listens. Two important things about homecare:
1) It is more cost effective than any other setting for care for the patient; and,
2) And more importantly, patients tend to thrive better in their home care setting.
In the new norm of patient centered care, it is time for all involved in healthcare delivery to provide the means to provide care in the best interests of the patient.
Very informative article, very well written