Raising state Medicaid pay rates and financial support for nursing homes and greater accountability for supplemental staffing agencies are getting a hard look from the Kansas legislature and provider advocacy organizations.
They met during a bipartisan committee hearing last week to address skilled nursing staffing shortages, a major culprit causing strife and facility shutdowns in Kansas and many other states.
The hearing specifically dealt with a domino felled by staffing shortages, use of agency staff. Last year, nursing homes nationwide saw an 83% increase in their median contract labor use compared to 2020, according to a report issued in October by accounting firm CliftonLarsonAllen.
Advocates complained that agencies were price gouging to take advantage of providers’ dire needs, and they were making it difficult for agency nurses to leave for more stable opportunities.
Staffing agencies include large buyout clauses in their employee contracts in order to discourage facilities from hiring nurses and aides who may want to leave an agency and work for a facility, Rachel Monger of LeadingAge Kansas told McKnight’s Long-Term Care News.
“Some staffing agencies are even known to put non-compete restrictions in their contracts with nurses to prevent them from going to other agencies or facilities in the area,” she said.
Staffing companies were charging Medicaid providers more than triple the typical rate for essential workers, Monger told Home and Community Based Services and KanCare Oversight Committee.
Prohibit restrictive agency clauses
One solution is for the state to pass legislation that prevents staffing agencies from using buyout and non-compete clauses in their contracts with facilities and nursing staff, Monger said.
“Nurses and nurse aides are free to go work for a temporary staffing agency any time they’d like,” she said. “Our state cannot afford to have nurses and nurse aides held hostage so that staffing agencies can demand thousands of dollars more on top of the extortionate charges they are already demanding from nursing homes and hospitals.”
Committee members didn’t show much enthusiasm for government intervention in market-based business, and were reminded that the government funding aspect made the agency-provider relationship unique, according to a media report.
Cutting the number of training hours needed for CNA certification was a move supported by Rep. Brenda Landwehr (R-Wichita). Kansas currently requires 90 hours, but the federal Centers for Medicare & Medicaid Services requires 75.
When another legislator said 75 hours of training might deliver unprepared workers to critical environments and duties, Landwehr countered, “It doesn’t mean we’re losing quality. It means Kansas was sitting too high. Why in the world are we sitting here at 90 hours with the feds at 75?”
“People are going to have to get off their turf-battle stances,” Landwehr said. “We’ve got to make changes because we’ve got to figure out how to increase this workforce. We’re going to have this discussion in every area of health care whether people like it or don’t like it.”
‘Miles away from the ideal’
Monger said she doesn’t love the reduction of training hours, but there’s little room for luxury. Her organization has been pushing for staffing agency oversight legislation since 2020.
“Our state legislature has challenged all of us to look at licensure and certification training through the lens of wants versus needs,” she said. “In an ideal world, we would include as many training hours and topics as possible for certified nurse aide programs.
“But we are miles away from the ideal, with no relief in sight. If the federal government believes 75 hours of training is an adequate and safe amount of clock time to cover the federally required curriculum, we are willing to have a public and multi-stakeholder conversation around adopting the CMS standard in Kansas.”