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Home health care nurses in short supply

Nurse Leader Weekly, January 5, 2004

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Across the region, home health care agencies are turning away hundreds of patients every month because of a shortage of visiting nurses. The problem is particularly acute on holidays and weekends and has been growing as hospitals seek to send patients home quicker and sicker, and agencies struggle to fill nursing vacancies.

"It's a silent crisis," said Carolyn Markey, chief executive of the Visiting Nurse Associations of America in Boston. Silent because few patients complain publicly, afraid that would make it even harder to find care.

While no one has collected statewide data, area agencies reported turning away 30 to 200 patients a month.

The patients facing the greatest difficulty getting care are those who need it most, such as patients with complex home care regimens who require once- or twice-daily visits from a registered nurse. The majority are elderly, without family.

The Home Health Care Association of Massachusetts estimates that 10,000 more Medicare patients in Massachusetts will be served by home health workers this year than the 90,000 seen in 2001 and 2002. Medicare patients account for the bulk of the association's clients.

Hospitals, which account for the majority of home health care referrals, are working harder to line up home nursing for patients. Hospital discharge planners nationally told a Medicare advisory committee last year that they were having problems securing care for patients with wounds and other problems that needed daily attention.

In Massachusetts, hospital workers say they regularly start calling nursing agencies three or four days before a patient is actually ready for discharge. Often they need the beds for other patients.

American Hospital Association figures show there is a shortage of more than 100,000 nurses nationally in hospitals alone. Home health care agencies compete with hospitals and nursing homes for registered nurses, but typically cannot compete on salaries.

Many home care agencies operate at a loss because of high costs and low reimbursement from private insurers and the state Medicaid program. Medicare, which funds the largest chunk of home nursing, pays better, but not enough to make up for the other insurers, home health agency officials said.

Congress has cut Medicare payments for home nursing, most recently last year, deciding it was growing too fast. Federal spending dropped from a high of nearly $18 billion in 1997 to about $10.5 billion last year.

Agencies say they don't pick and choose patients based on how much they will be reimbursed by insurers, but those who have studied the issue say reimbursement is a potential problem.

Adapted from www.boston.com.

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