Home health providers and hospitals have a long history of going head-to-head when it comes to nursing talent. In some ways, the COVID-19 pandemic has only intensified the competition and left providers in the position of having to shell out more to recruit staff.
In general, recruiting could often be an uphill battle for providers, even prior to the public health emergency.
And as nursing school enrollment struggles to meet market demands, the U.S. has seen a shortage of registered nurses.
Factors such as not having enough nursing school faculty members, rising nurse retirement rates and the aging population in the U.S. have also contributed to this shortage, according to the American Association of Colleges of Nursing.
Overall, there will be about 175,900 openings for registered nurses each year through 2029, according to data from the Bureau of Labor Statistics.
On top of this, home health providers typically have a smaller pool of nursing candidates to choose from. Several factors are to blame.
For starters, many nursing programs prioritize institutional settings. Even before new nurses are officially on the job market, their time as students hasn’t left them trained to work in the home, Nancy Bohnarczyk, clinical assistant professor and nurse residency program director at Rutgers School of Nursing, told Home Health Care News.
Located across four campuses in New Jersey, Rutgers School of Nursing is one of the nation’s largest nursing schools.
“They don’t have a lot of exposure to home health while they’re in school — many of them do not see it as a career path when they graduate,” Bohnarczyk said. “Most of their experience in school has been in the hospital setting, so that just seems to be the natural flow for them to pursue. It is an environment they’re a little more familiar with.”
Home-based care executives have echoed those sentiments.
The public health emergency has only served to worsen staffing shortages for home health providers, Jennifer Sheets, president and CEO of Interim HealthCare Inc., told HHCN.
“For the last several years, there has been the shortage, and it’s always been a challenge to recruit,” Sheets said. “But quite honestly, the pandemic has even exacerbated the existing workforce challenges that home health and health care, in general, have been experiencing. We’re all trying to fish from the same pool.”
Interim is a Sunrise, Florida-based in-home care franchise company with more than 300 locations across the U.S.
One of the most common ways to attract new talent while retaining the current workforce is to increase wages. For the most part, providers have stepped up on that front.
In 2020, the average hourly rate for registered nurses working at home health agencies
increased 2.29%, according to data from the Hospital & Healthcare Compensation Service.
Despite this, hospitals are often in a better position than home health providers when it comes to the ability to raise pay.
“Hospitals are larger and have a better paying ability,” Rosanne Zabka, director of reports for the Hospital & Healthcare Compensation Service, told HHCN. “They have a better class of benefits because what the [nurses] receive is part of what the entire hospital packages for their physicians, etc. They have more funding under their belts versus a mom-and-pop home health agency that’s just as a single owner.”
Zabka noted that the exception is hospital-run home health entities. Last year, nurses working at these organizations saw the highest pay among those working in agencies — with an average hourly rate of $38.43.
Staying in the game
Still, there are a number of ways providers can stay in the game when it comes to attracting nursing talent, even with the rising labor costs.
At Interim, this means providing opportunities for career development and education.
“We have developed and invested in specialized training programs, and professional development initiatives, to help attract and keep top talent,” Sheets said.
The company recently celebrated the 11-year anniversary of the Interim HealthCare Learning Center, the company’s hub for clinical professional development.
“Employees who feel valued are more motivated to stay and have the knowledge to provide better care to our patients and clients,” Sheets continued. “The best part is that they recommend us as their employer to other similarly wired friends and colleagues. That’s where the virtuous cycle of our efforts pays off.”
It’s important to mention that nearly all health care providers are facing staffing struggles; it’s not just home health agencies.
In February 2020, U.S. health care employment reached nearly 16.5 million jobs, according to nonprofit research and consulting firm Altarum. As of this February, the health care workforce is smaller by about 3.5% — a loss of about 15.9 million jobs.
Though the public health emergency has contributed to staffing shortages across health care, it has also given providers the opportunity to make nurses reconsider home health.
“As a sector, we need to attract the best and the brightest,” Dr. Anna Loengard, AccentCare’s chief medical officer, said during a recent HHCN webinar. “We need to position ourselves as something new and different … the future of medicine.”
Similarly, Sheets believes that now is the time for providers to really sell the benefits of working in the home as opposed to more institutional settings.
“An attractive element of home health care that we are working to raise awareness of, especially as so many non-home health care nurses experience burnout and unsustainable nurse-patient ratios, is that it’s a perfect place to consider changing lanes to,” she said. “Given the unique nature of the one-on-one care, the incredibly rewarding privilege of caring for the patient in an autonomous setting where their actions and response are so impactful, the deeper connection with their patients, or the flexible hours and variety of positions available at all experience levels.”
As far as nursing programs, Bohnarczyk noted that she is starting to see a slow shift when it comes to training up-and-coming nurses in the home.
“While the majority of the training is going on in hospital settings, there’s now starting to be more exposure to home health and community settings, as we look more at population health and in treating people in their environment versus having them come into an institutional setting,” she said
Bohnarczyk added that the Rutgers residency program recently produced three graduates who went on to work in home health.
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