Iowa Ideas: Staffing shortages, flat funding impacting patient care

The question that wakes Iowa’s health care leaders up at night is whether they will have enough nurses and other staff to care for Iowa’s patients and long-term care residents.

“The most challenging issue that is systemic is the workforce shortage,” said Angela Van Pelt, Iowa’s long-term care ombudsman. “In our world, it’s people who work in long-term care facilities, from CNAs (certified nursing assistants) to administrators. We’re having so much turnover and you can imagine how that impacts the quality of care for residents.“

Staffing solutions

Health care leaders across the United States have been grappling with staffing shortages for years, fueled by low wages and lack of prestige in some positions. The COVID-19 pandemic brought retirements and new staffing models, some of which haven’t been conducive to employee retention.

Recognizing this ongoing challenge, the first health care session of the Iowa Ideas virtual conference set for Oct. 12 and 13 examines creative staffing solutions, such as recruiting internationally-trained staff, using technology to ease workforce pressures and tweaking educational requirements for would-be caregivers.

Van Pelt, who is participating in a panel discussion Oct. 13 on the Needs of Aging Iowans, said she’d like to see the state consider creating a tax credit or subsidy that would go directly to health care workers in fields of need. To help nursing homes with administrative turnover, maybe the state could provide something like a SWAT team that provides support for a week or two, she suggested.

Flat Medicaid reimbursement despite rising costs

Chris Mitchell, president and chief executive officer of the Iowa Hospital Association, said Iowa hospitals are feeling the financial strain of stagnant Medicaid reimbursement even as inflation has increased costs.

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“Just this constant call for the hospitals to do more with less is something that they have answered the bell for time over time,” Mitchell said. “We did see our first hospital closure in 20 years last year in Keokuk. What more can we do to ensure all the hospitals stay viable?”

Keokuk, a city of nearly 10,000 in Southeast Iowa, has been without a hospital for a year, when Blessing Health closed, citing low demand for inpatient and emergency services, Iowa Public Radio reported. Mercy Iowa City has filed for bankruptcy protection and may restructure as something besides a hospital.

Medicaid reimbursement and workforce challenges likely will be a topics Oct. 12 at the Iowa Ideas health care Leadership Roundtable, Mitchell said.

‘Treat our bodies like we do our cars’

Preventative medicine — everything from exercising and healthy eating to seasonal flu shots and regular physical exams — is key to warding off illness and catching medical conditions early.

During the height of the pandemic, many hospitals postponed non-critical surgeries, screenings and visits to focus on treating COVID-19 patients. That was necessary at first because of a shortage of protective equipment for staff, but Dr. Dustin Arnold, chief medical officer for UnityPoint Health- St. Luke’s Hospital in Cedar Rapids, said the hiatus lasted too long.

“If I could do it again, I’d be more aggressive in resuming those screenings,” said Arnold, who is part of an Oct. 13 Preventative Care panel discussion.

Preventative care visits at St. Luke’s have returned to about 75 percent what they should be, Arnold said. To get closer to 100 percent, the health care community needs to rebuild trust with some patients.

“You can’t ignore than some patients have lost trust in health care because of things that happened during the pandemic,” he said. “We were told ‘Get the vaccine and you won’t get it (COVID-19)’ or ‘Get the vaccine and you won’t spread it’. That wasn’t always accurate.”

But there are so many reasons to resume regular visits and screenings, including for young people. Arnold pointed to a study published in August showing cancers presenting in younger patients.

“We could have a tsunami of cancers because it’s presenting earlier and we missed two years of screenings,” he said.

Some clinics are letting patients schedule their own appointments online. Arnold also appreciates when patients get online coaching in exercise, healthy eating or sleep hygiene.

“One of the paradoxes in health care in humans is I get my oil changed right at the mark you’re supposed to,” Arnold said of his car. “But it’s not uncommon for me to have my screening exams later than I should. I wish we’d treat our bodies like we do our cars.”

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