STAFF RECRUITMENT.

Adapted from testimony to the House Subcommittee on Oversight and Investigations--Committee on Education and the Workforce

What have we at Harborside done to address this crisis? You name it. We have hired extensively from the welfare rolls. The nursing home industry, in general, has hired more than 50,000 welfare recipients in the last three years. Most are single mothers whom we train to become certified nursing assistants and put on a career path in healthcare. All too often they will complete their training with us, then are hired away by hospitals or other providers who do not have to deal with our heavy reliance on government-set payment rates.

We perform criminal background checks on each potential employee. This process significantly adds to costs but eliminates an estimated 10% of applicants from eligibility for hire, and appropriately so.

We have offered signing bonuses of $1,500 for certified nursing assistants--and even higher for licensed personnel.

We have set up tables in grocery stores to recruit new employees, sent direct mail and posted job openings in communities, schools and even laundromats.

Every one of my facilities has a recruitment and retention committee. We make great efforts to reduce turnover and maintain a stable workforce through flexible scheduling, employee-appreciation efforts, mentoring programs, and much more. Yet it is still not enough.

We offer multiple incentives for recruitment. We have flexible scheduling, very generous benefits, recruitment bonuses, shift differentials, float incentives, pay in lieu of benefits, and many other programs to attract the dedicated caregivers we need.

The cost of labor is, without a doubt, the largest and most important investment any nursing facility makes. On average, 67% of nursing home expenses are for staffing. The remaining supports care supplies, food and medicine, therapies, activities, utilities, and building maintenance and improvements.

Certified nursing assistants, who provide the overwhelming majority of hands-on care to patients, receive between 75 and 150 hours of training and must pass a certification exam before providing care. This training costs an average of $2,000 per employee. We also provide continuing education and in-service training to keep our caregivers up to date with the latest technologies and best caregiving practices. The unfortunate reality, however, is that there are not enough people willing to fill these critical jobs. That forces us to use our last resort-contract nursing staff.

Contract nursing is a particular problem in nursing homes. It disrupts the continuityof care that residents receive, and residents cannot form long-term relationships with contract staff that help make facility life meaningful.

Not only does contract nursing disrupt continuity of care, but it is far more expensive. I spent roughly $3 million on contract labor in 1997. Last year that amount escalated to more than $8 million, which includes over $2 million in premiums paid to the agency-funds that could have been channeled to more productive purposes, including wage increases, employee recognition or care improvements. I pay $18.66 per hour for a contract CNA, compared to $10.39 for hourly salary CNAs.

I have made it a company goal to work to eliminate contract nursing. We recently sent every home a list of 44 suggestions to reduce contract labor, yet because of the labor market, I am still forced to use agencies in half my nursing facilities.

If there are no available prospective employees and contract nursing is undesirable or unavailable, the only options are to refuse to admit new patients or close all or part of facilities. Some companies and government facilities have closed entire wings or units as a means of coping with the staffing shortage. Others do not admit new patients, even though they have available beds. My company currently is considering closing beds because of the staffing shortage. Our Petersborough, New Hampshire, center has struggled to find personnel. The staffing shortage forces us to choose between quality of care and the number of residents we serve. I will tell you that when faced with this choice, quality of care wins every time. But, make no mistake about it, this will result in an access-to-care problem in communities like Petersborough across the nation.

I would like to present several solutions that will address the staffing crisis:

* I would like to increase staffing and increase wages, but I am not permitted to because the Medicaid and Medicare reimbursement levels do not al-low me to. Please urge your colleagues in Congress to invest more in our nation's elderly and fix these broken and underfunded programs by enacting a wage pass-through for Medicaid.

* Please grant a permanent extension of the Work Opportunity Tax Credit, which will facilitate moving still more welfare recipients into the workforce.

* Several states, e.g., Wisconsin and Florida, have taken steps to use federal funds to enhance support for training programs specifically focused on meeting the labor needs of the long-term care industry. Please enact Public Health Service scholarship grants, which will fund training programs for CNAs, LPNs and RNs.

* Please give special consideration to permitting new entry for immigrants with nursing skills, as well as increased unskilled labor.

* Allow part-time staff to be trained as nutrition assistants, who could then help residents at mealtimes.

* Please urge the Clinton administration to fix the (regulatory) system. We need smarter government that works closely with caregivers to identify and fix problems together.

Doesn't that sound like a system in the best interest of patient care?

National Association of Geriatric Nursing Assistants (NAGNA) Five-Point Plan (adapted from testimony at the Senate Special Committee on Aging "Staffing in Long Term Care" Forum)

I. Launch a national recruiting campaign.

We believe there are thousands and thousands of people who are potentially special CNAs; we must find them, motivate them and educate them on how they can make a difference.

II. Enact d government-funded "direct wage pass-through" for the Medicaid program.

NAGNA's goal is to see the national average CNA wage reach $10 to $12 per hour in the next two years.

III. Avoid mandating minimum staffing ratios.

NAGNA estimates that nationwide there are currently more than 200,000 openings for quality CNAs. No one is unwilling to hire CNAs; there is simply a lack of qualified applicants! Mandating ratios would only result in surveyors writing staffing deficiencies in every facility across the nation.

IV. Establish a national CNA registry.

Criminal background checks conducted by individual states do not protect a facility from hiring a CNA who has committed resident abuse in another state. A national registry would allow facilities access to this information.

V. Support uniform national credentials and education.

Our members are most supportive of the (job title), Certified Nurse Technician. NAGNA (also) calls for the enactment of regulations that allow a facility to withhold the cost of the (training) course from the nursing assistant's pay, should s/he terminate employment within a one-year period of completing the course. Quite simply, facilities should be allowed to enforce a length-of service contract.