"Everywhere we go anywhere in the state, when we talk to health care providers and aging service providers, the number one concern that's keeping them up at night is staffing. 100 percent."
Those words from Rachel Monger, vice president of government Affairs at LeadingAge Kansas, summarize the frustration felt across almost every industry in the state. Monger's organization represents nonprofit agencies providing aging services throughout the state, and 60 percent of those members are located in small, rural communities.
They can't find enough staff to provide services to take care of the elderly or fill other health care needs.
"That's the biggest thing when you're talking about how many services you can provide and in what way," Monger said. "Staffing — it doesn't matter where you are in the state of Kansas — in long-term care is at crisis level."
Monger said other states face the same situation and much of the conversation on a national level is about proposing different models to address the staffing shortages.
"But it's a big thing to get our arms around," she said. "We have to keep trying, and we have to think further and further outside the box."
LeadingAge has had a blue-ribbon commission for the last few years looking at ways to improve staffing and change things they have control over.
"We are working a lot on workplace culture, on retention and trying to get those turnover rates down, working with lawmakers and even educational institutions and state agencies about how we can open up that pipeline of workers more," she said.
But the challenges are many. Pay is one.
"What you hear from a lot of our members is Amazon opens up or Walmart starts hiring and we can't compete with those wages," Monger said, adding that wages have risen to try to compete but there's a limit they just can't exceed.
"There's a ceiling to what we can pay for nurse aides and nurses," she said. "More than half of the elder people in nursing homes receive Medicaid. We have a big ceiling on our funding in terms of what we can pay for workers."
Monger said there are no indications that Medicare and Medicaid, which are administered through the federal government, plan to adapt reimbursements to allow health care be more competitive in paying wages.
"A lot of this is going to be at the state level," she said. "We know that it's on their radar certainly."
In 2017, the Kansas Department of Health and Environment put published the "Kansas Primary Care and Rural Health Professional Underserved Areas Report." It broke down health care needs throughout the state, highlighting professional shortages in primary care, dental health and mental health.
The state has stepped up programs to address shortages, said Cynthia Snyder, KDHE director of special population health, primary care and rural health. There are a number of programs in place that help attract physicians to practice in rural areas.
The Kansas Bridging Plan, for example, offers loan forgiveness for primary care and psychiatry residents provided they practice for at least 36 months in underserved counties in the state. Each year the state funds up to 13 slots for primary care and three slots for psychiatry.
Eighty-five percent of the physicians continue practicing in Kansas once they complete their commitment, according to the KBP website.
Another option, Snyder said, is the J-1 Visa Waiver program, Snyder said. It helps to facilitate immigration for doctors by waiving the two years they would need to return to their home countries after completing their residencies provided they commit to practicing in designated locations where there are health professional shortages.
The program has brought many doctors to the state, Snyder said. The visas are administered by the U.S. State Department and each state gets 30 slots.
Monger said that on a national level, there is more and more discussion about the importance of foreign-born workers.
"These are the kinds of topics that we in health care, certainly long-term care, have never dipped our toes into, but the with the way things are going, we're starting to get into bigger and bigger issues that are touching our field," she said. "The biggest one is workforce and where are we going to have the people to take care of older folks across the nation, not just in rural areas."