Health care, support positions going unfilled
With their workforce already stretched thin, Okanogan County hospitals are looking at strategies to remain viable – and open – particularly as the need for health care grows as baby boomers age.
Mid-Valley Hospital CEO Alan Fisher posed the ultimate question: “How do we keep the hospital open when we don’t have staff?” Mid-Valley doesn’t want to cut beds, particularly now, when the hospital is seeing higher demand, both because of COVID and other conditions, since some people postponed care during the pandemic, Fisher said.
Fisher and executives from the county’s two other hospitals, economic development and education organizations discussed health care staffing challenges at the October meeting of the Okanogan County Coalition for Health Improvement.
Stress and burnout during the pandemic have accelerated resignations and early retirement, exacerbating long-standing difficulties in recruiting enough workers to fill patient-care and support positions, the hospital executives said. Other chronic issues, including a shortage of suitable housing and child care, add to the challenge.
Some facilities are getting by with sparse staffing, but others have already reduced services. Mid-Valley, in Omak, has recently been forced to divert patients to other hospitals because it didn’t have enough staff to provide safe coverage. The hospital cut operating rooms and reduced elective surgical procedures by about 30% because half of its operating-room staff are retiring by the end of this year, Fisher said.
Mid-Valley had 28 open positions at the end of October, including 16 spots for registered nurses, Fisher said. The hospital is also looking to fill jobs for lab and radiology technicians and support positions like cooks.
It’s difficult for small hospitals to keep their doors open – not because they can’t afford it, but because they don’t have the staff to cover all the jobs, Fisher said.
People in many sectors left the workforce during the pandemic, but the level of burnout among health care workers – and their subsequent exodus – is among the highest, Roni Holder-Diefenbach, executive director of the county’s Economic Alliance told the panel.
Three Rivers Hospital in Brewster is confronting similar issues, CEO Scott Graham said. The need keeps going up, but there aren’t enough doctors and nurses to match the demand, he said.
Three Rivers had a nursing shortage even before the pandemic. The hospital is facing greater workloads in the laundry, dietary and housekeeping departments, Three Rivers Business Development Coordinator and Public Records Officer Jennifer Best told the Methow Valley News in an interview last week.
Having a lean staff means workers struggle with burnout as they take on more tasks and try to be more efficient, Graham said. Some nurses quit because they didn’t want to go through the stress as the COVID Delta variant loomed, Best said.
Hospital employees are also dealing with the tension of caring for patients who are more severely ill when they are admitted. Some postponed care during the pandemic, and others were delayed by insurance issues, Best said.
The state vaccine mandate had little impact on staffing, all three hospital administrators said. Still, “it didn’t help,” since it may have pushed out employees who don’t want to be told what to do, said Graham, who nonetheless called the mandate “the right thing to do.”
Despite being short-staffed, Three Rivers has been able to provide the necessary level of care, Best said.
Hospitals are trying a variety of solutions. Mid-Valley has been filling nursing and other posts with traveling staff, but that means significantly higher costs. From August through October, the hospital spent $464,000 on traveling staff, $414,000 (89%) of it on nurses, Fisher said.
Those added costs strain already tenuous finances, since reimbursement for patient care is set at a fixed amount, with Medicare and Medicaid paying from 45 to 48 cents on the dollar, Fisher said. Two-thirds of their patients are covered by one of those programs, Fisher said.
Using traveling staff is not sustainable, and the situation is getting more competitive – and more expensive – because agencies that supply travelers bid hospitals against one another, Fisher said.
“With this current crisis, if we don’t solve the employee staffing problem today, there won’t be a hospital for this county tomorrow. That is what is so critical,” Fisher said.
Small, aging workforce
Okanogan County already had a very limited workforce before the pandemic, Holder-Diefenbach said, pointing to numbers from the state Employment Security Department.
Among people 16 to 65, there are only about 500 not currently in the workforce. They may be retired or simply don’t want to work. As a result, all businesses are competing for just a few hundred people. Moreover, Okanogan County has one of the oldest pools of workers in the state, Holder-Diefenbach said.
In mid-October, only 214 people were collecting unemployment benefits in the county, said Kristi O’Neill, community and business engagement coordinator for WorkSource Okanogan and WorkSource Wenatchee. That’s a significant drop from May 2020, when there were 2,251 people collecting benefits, she said.
With the high cost of child care, employers are increasingly seeing one parent opt to stay home, Holder-Diefenbach said. Women have been leaving the workforce in record numbers, frustrated by the lack of support for balancing family life and work, she said.
Recruitment to Okanogan County has historically been the top challenge. The county needs more housing and child care options to be able to attract workers, Holder-Diefenbach said.
Suitable housing is a significant barrier in attracting people to health care jobs, said Sue Kane, Director of STEM Initiatives & Strategic Partnerships at the North Central Educational Service District (NCESD). The shortage of affordable housing is a barrier for people in lower-level jobs, but even people who earn high salaries, like physicians, can’t find housing to accommodate their family and preferences, Best said.
On at least one occasion, Three Rivers extended an offer to someone who ended up declining the job because the person couldn’t find a place to live, Best said.
While it takes longer to attract providers with a passion for rural health care, those people typically make a long-term commitment, Best said.
Hospitals are also looking to the foreign market, where there are credentialed health care providers who could work here with proper visas, Fisher said.
Salaries in Okanogan County are competitive with other rural areas, but not with urban areas, Best said. Mid-Valley has tried hiring bonuses and a “work where you play” advertising campaign, Fisher said.
Not only does the crisis affect the health care sector, but it affects the overall quality of life in the county, since people don’t want to live in an area without good health care, Graham said.
Working toward solutions
Hospital administrators are already talking with schools, community organizations, and hiring and job-training centers to prepare for increased demand.
Recruiting workers to Okanogan County from other areas can be difficult, O’Neill said. But there are excellent opportunities for creating education and certification programs in local high schools, she said.
WorkSource and the North Central Educational Service District (NCESD) are working to develop more areas of study in Career and Technical Education (CTE) that would introduce students to health care jobs and allow them to graduate with a certificate so they are employable right away.
WorkSource and the NCESD are working on a program that will provide navigators to help people understand health-care job options and to create on-the-job training, O’Neill said.
Some collaborations are already underway. North Valley Hospital in Tonasket has trained students to be certified nursing assistants, CEO John McReynolds said.
McReynolds is optimistic. North Valley also has a partnership with the Washington Association for Community Health to develop apprenticeships for high school students as medical assistants, he said. And many people are drawn to this area, particularly after COVID.
Wenatchee Valley College offers almost 20 programs in health care fields, from nursing to pharmacy technicians to nutrition.
Liberty Bell High School is now offering coursework in anatomy and physiology, but not a full path to a certificate, Principal Crosby Carpenter said. The school’s CTE coordinator has been exploring the potential for a medical sciences pathway and has met with at least one potential community partner. Still, all these options require a significant investment in staffing and training, and the school doesn’t want to spread itself too thin, Carpenter said.
Okanogan County has 145 physicians, just 0.7% of the state total, but that’s considerably higher than other counties in eastern Washington, which have just 0.1% or 0.2%, according to a 2021 overview of physician supply by the state Office of Financial Management. The median age of the Okanogan County’s physicians is 55. The vast majority of physicians statewide are in their 50s, according to the report.