The COVID-19 pandemic presented state and local health care leaders with an extraordinary workforce shortage. The millions in federal relief money that followed presented an extraordinary opportunity to tackle it.
And now, a group of health care, education, and state leaders has 107 suggestions for doing so.
Two years in the making, Giving Care: A Strategic Plan to Expand and Support New Hampshire’s Health Care Workforce has both immediate and long-term recommendations, from retaining staff with wellness programs and professional mentorships to persuading Medicaid, Medicare, and private insurers to expand coverage to case management and community health workers. Some recommendations require policy changes or new funding, while others need no money but rather collaboration among stakeholders and the creation of a central repository for the state’s scattered workforce data.
“In this state, we address problems often in very siled ways,” said Kim Firth, program director at the Endowment for Health, which funded the project and partnered with the Community Health Institute to lead it. “We want this to be action oriented. We don’t want this to be a plan that sits on a shelf. We actually need to work together to implement it.”
Health care is among the state’s largest sectors, with an estimated 62,250 workers. Workforce projections show nearly all specialties growing; nurse practitioner positions alone are estimated to increase nearly 60 percent by 2030, according to the state Department of Employment Security.
The two organizations are rolling out the plan quietly with a broad audience in mind that includes not just hospital human resource managers and state agency heads but also nonprofits, health care advocates, and lawmakers. And they say parts of the plan – such as prioritizing employee career development and using technology to reduce workloads – are transferable to any industry.
Firth and Margaret Franckhauser of the New Hampshire Community Health Institute have been encouraged by feedback on the plan.
Franckhauser said that at one recent meeting Health and Human Services Commissioner Lori Shibinette encouraged the nearly 65 attendees to read the plan and choose three to five priorities they thought the department could fund, lead, or play a role in executing.
“She said very clearly to the group, ‘There is limited funding we have, and we are interested in your ideas about where we can put some of this money,’” Franckhauser said.
The plan’s 107 strategies fall into four topics: recruiting and retaining health care workers; rethinking policies that stymie workforce development; collecting and using data to drive decisions; and creating a public or private group to move the plan forward to ensure it doesn’t get shelved.
It’s the first one that gets the most attention.
Like the rest of the plan, strategies for expanding the workforce “pipeline” range from those that are relatively easy to implement to others requiring one- to two-year investments.
Rather than only do exit interviews, the plan recommends periodic retention interviews to learn what’s working and what needs improvement. It suggests recruiting creatively by marketing the health care field to older workers as a “second career” and encouraging parents to promote the field to their school-age children.
Harder to accomplish are recommendations like providing more tuition assistance and livable, competitive wages.
Heather Carroll, director of advocacy for the NH Alliance for Healthy Aging and among the 70 people who worked on the plan, noted licensed nursing assistants can earn more in Maine, Massachusetts, and Vermont than the $11.25 average hourly wage in New Hampshire. She also said LNA’s from New Hampshire are “golden” to neighboring employers because their training allows them to administer medication.
“During the pandemic, (other states) were willing to give stipends for living expenses and a transportation stipend if they came to Massachusetts,” Carroll said. “When you’re trying to meet needs and you are the sole provider in your home, those options become very appealing.”
Also appealing, Carroll said, is a job that provides a dependable schedule rather than requiring workers to stay past their shift to cover a staffing shortage, a not uncommon practice across industries.
Low wages have decimated the direct care workforce, which allows aging seniors and people with disabilities to receive care at home and stay out of a nursing home. Choices for Independence, a federal program that reimburses providers for those services, is a major provider of that home-based care.
“CFI is much cheaper than putting someone in a nursing home, which relies on public dollars,” Carroll said. “So why isn’t the state investing in this?”
Other ideas include creating a central listing of internships, mentorships, and field-training opportunities for students and making it easier and faster for in- and out-of-state providers to be licensed in New Hampshire. Lindsey Courtney, who is head of the state’s licensing office and helped create the plan, has already made that a priority.
The plan acknowledges but does not try to solve perhaps the biggest challenges to growing any workforce in this state: a dearth of affordable housing and child care. It recommends employers mitigate these barriers by providing financial assistance for both.
Will Stewart, executive director of Stay Work Play, encounters the enormity of those challenges in the nonprofit’s efforts to bring new people to the state.
“Many health care workers, especially entry-level workers, are low paid. That’s not uncommon for entry-level workers in a number of industries,” he said. “Coupled with high housing costs, coupled with high student debt payments … and the fact that you are going to probably have a car payment because public transportation isn’t what I would call robust, New Hampshire is an expensive place to live.”
One woman’s comments stuck with him from a recent visit to the Upper Valley. “She said it’s a great place to raise a family but it’s a terrible place to start one,” he said. “People want to live here, want to stay or move here, but they just can’t afford to do it.”
Stewart is encouraged by what he sees as increased momentum in trying to address both challenges.
In prior roles, Franckhauser, who managed health care organizations before joining the Community Health Institute, recruited health care staff by enticing employees away from competitors. Her thinking on that has changed, and she believes the fact that so many competing health care employers contributed to the plan shows a shared understanding that expanding the workforce is necessary for not only their office but the state.
“I think this process causes us all to recognize that a rising tide floats all of us and elevates all of us,” she said.