In a pandemic, is it a price hike to charge a premium for emergency nurses?

As the delta variant crumbled in Idaho last fall, a hospital staffing shortage turned into a staffing crisis — and gave way to a costly exchange.

Hospitals would lose nurses to lucrative, short-term contracts with recruiting agencies that offered more than $4,600 to $8,000 per week, sometimes with a housing allowance in addition to salary. And each time a nurse left, her post had to be filled. So hospitals turned to these same recruiting agencies to fill vacancies, and the agencies charged the hospitals a premium on top of the worker’s salary and benefits.

The same has happened in all health care settings, according to the representative of an industry group that wants to set limits on what staffing agencies can charge.

A bill presented on Feb. 11 and referred to the Senate Commerce and Human Resources Committee would add temporary health care workers as a category under Idaho’s consumer protection law that prohibits price gouging — charging “an exorbitant price or excessive” in an emergency.

Other States, Industry Groups and Members of Congress pondered similar bills and called for investigations into the high rates charged by healthcare staffing agencies during the pandemic.

Robert Vande Merwe, executive director of the Idaho Health Care Association, said he was not optimistic that the Idaho bill would pass this session. A hearing to discuss the bill before the committee has not yet been scheduled.

“Most lawmakers are suspicious of any kind of legislation that doesn’t appear to be free market,” he said in an interview with the Idaho Capital Sun. Vande Merwe’s group represents long-term care facilities in Idaho.

But, said Vande Merwe, health care is not always a free market.

For long-term care facilities, those accepting patients with Medicaid health insurance cannot afford to pay higher wages, he said.

Bill would not cap nurses’ pay, ban predatory pricing

Just like in hospitals, jobs in nursing homes, assisted living facilities or group homes can be physically and emotionally taxing. Health workers said they felt undervalued and overworked during the pandemic, often because staffing shortages forced them to take on more work.

When an employment agency offers them a higher salary, some of them jump at the chance to at least make more money – or, in free market terms, get paid what it’s worth — and their departure exacerbates the lack of personnel.

“It’s a downward spiral,” said Vande Merwe, describing the phenomenon that has become well known in the pandemic. “You kind of have to use the agency (staff) because there’s no other choice. … A hospital told me that the nurse was paid $75 an hour, but the rate (charged) to the hospital is $250 an hour.

He said companies are “grateful to agency staff when they are available,” but nurses and aides who come on temporary assignments don’t know the patients, shift cadence, or work processes. ‘establishment.

The phenomenon also surfaced at the Senate Health and Welfare Committee on Tuesday when Sen. Michelle Stennett, D-Ketchum, asked a nursing industry leader about rural Idaho nurses leaving their employment for more lucrative and flexible travel nursing contracts.

“I was a manager at Saint Al’s for a long time, and a good friend of mine who was an ER nurse there just told me he quit because he took a job at a travel agency for 7 $300 a week at St. Peter’s in Olympia, Washington,” said Randall Hudspeth, executive director of the Idaho Nursing Centersaid this committee.

Vande Merwe told The Sun that many of the temporary healthcare workers who work under agency contracts aren’t crisis travelers from other states to help — but are actually Idaho residents. who quit their jobs and were hired by an agency to continue working here.

We knew we had a problem (on the horizon with elder care for baby boomers) but, my goodness, the pandemic has made it a reality now. … There are no robots to help wash or care for our elders.

– Robert Vande Merwe, Executive Director, Idaho Health Care Association

Vande Merwe acknowledges that if Idaho were to regulate health care personnel costs, Gem State could lose out to other states where agencies are allowed to charge whatever they want.

“We just want a check and a balance between what is abusive practices and what is reasonable,” he said. “But it has to be abusive” for the law to be broken. (If an agency is forced to charge higher rates because workers demand higher wages, this would not be considered a price hike.)

“We can send a letter that says, you know, this sounds outrageous; we have this law here, and we want to use you, but…” said Vande Merwe.

For their part, recruitment agencies say they are not making a fortune from the pandemic. They had a profit margin of 12.4% in 2020, according to a article published last month by the American Staffing Association. The document does not list a profit margin for 2021, when the healthcare workforce crisis was at its worst in Idaho and most other states.

“The cost of nurse staffing services has risen not only because of unprecedented demand, but also because the supply of nurses has suffered due to the unusually difficult working conditions caused by Covid,” the newspaper said. .

“Stress and overwork, physical danger and, in the case of traveling nurses, extended periods away from home, have all led to burnout, long leaves and retirements which have significantly reduced the number of nurses available to work,” the paper said. “This imbalance between supply and demand has forced nurse recruitment agencies to offer significantly higher salaries to attract and retain nurses, which has necessarily driven up the cost of agency services.”

“It has real impacts on everyone”

The situation for staff in Idaho care facilities is not good, according to Vande Merwe and others. And that has a ripple effect on the rest of the health care infrastructure, on patients and their families, on the economy.

A third of Idaho’s group homes and a quarter of Idaho’s assisted living facilities that took Medicaid closed last year, according to Vande Merwe.

Without enough room in understaffed care facilities, hospitals cannot discharge patients who need round-the-clock care for a disability or illness like dementia. Without a place to send patients, hospitals care for them for weeks or months.

A hospital told Vande Merwe that they had been trying to send a patient to a care facility “for a year”, he said. “How many COVID patients can you care for in a year? »

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Nursing homes and long-term care facilities have been understaffed since the pandemic began, and it has only gotten worse in recent months — contributing to the hospital crisis that has once again plunged Idaho into crisis care standards in January.

“There are still facilities trying to pay $10 to $12 an hour” because they depend on Medicaid payments, Vande Merwe said. Those salaries won’t fly in today’s job market, so “many” facilities are taking out loans to meet every payroll, he said.

When they can no longer afford to pay staff and can no longer afford the rates charged by recruitment agencies, establishments sometimes have to close. Some of them are residential and they realize they can either keep operating at a loss or sell their eight-bedroom home for $1 million in the current Idaoh real estate market.

“There have been families who are really in trouble,” he said. “‘OK, we’re going to try to take care of mum, who’s violent – and it’s not her fault, it’s the stroke or she has Alzheimer’s'” isn’t an ideal situation, did he declare. It is also impossible for most people who work full time to manage the care of a vulnerable adult.

“We need a safe place for these elderly and disabled people,” he said.

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