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Vacancy rates at Montana State Hospital remain high amid struggles to keep federal funding – Daily Montanan

['Keith Schubert', 'More From Author', '- March']

Date: 2022-03-15 00:00:00

Vacancy rates at the Montana State Hospital continue to plague the Warm Springs facility as it fights to keep federal funding after it was found to be out of compliance with federal standards.

According to a report from the Department of Public Health and Human Services, the overall staff vacancy rate at the hospital is 40% as of March 8. But the agency’s director, Adam Meier, said through the use of contracted workers, the actual rate is 10%. However, he acknowledged that strategy is not sustainable.

“It is certainly not sustainable, long term, financially or otherwise,” he told the Children, Families, Health and Human Services Interim Committee on Tuesday. Aside from finances, he said using contracted staff is not in the patients’ best interest.

“It isn’t optimal for continuity of care … we lose some of that institutional knowledge,” he said.

Still, between 2019 and 2021, data from the department shows an increased reliance on contracted staff and a decrease in full-time staff. By December of 2021, contracted nurse assistants were billed for 16,000 hours compared to just 2,000 in January 2021. And the number of full-time staff decreased from 450 in 2019 to less than 350 by the end of 2021.

Registered nurses were the most understaffed position at the hospital, with a 72.5% vacancy rate, followed by psychiatric technicians at 62%. And custodial positions saw vacancies rates of 54%, according to the report.

While the agency treads water with the contracted staff, they are significantly more expensive. According to the report, a registered nurse employed by the hospital makes $54.10 per hour compared to the hourly rate of $106.81 for the same position contracted out.

In recent months there have been multiple legislative hearings, federal investigations, and a flood of media reports revealing the hospital’s shortcomings. In February, the hospital was placed on “immediate jeopardy status” and became at risk of losing federal funding after an impromptu visit from the Centers for Medicare and Medicaid Services found the hospital did not comply with federal standards. The revelations include the death of four patients in five months, which the Centers for Medicare and Medicaid Services said were tied to the hospital’s inability to prevent falls and the complete absence of a COVID-19 prevention plan.

In public hearings, hospital staff have told legislators the bulk of the problems at the hospital stem from lack of pay and support, which Meier acknowledged at Wednesday’s meeting.

In the fall, the department started the process of hiring a private contractor to review operations at the hospital and other state-run health facilities.

“This is one of the main drivers of that, trying to help us with ideas for recruitment, retention … so that we could try to reverse course,” he said on Wednesday.

Meier also frequently points to raises issued to state hospital employees as a way to combat the staffing shortages. Since June 25, 2021, 169 employees at the hospital have received raises with an average pay increase of $2.58, or 11.18%, according to figures shared with the committee Tuesday.

Among those who received raises were 14 full-time registered nurses employed at the hospital, who received an average hourly bump of $6, or 18.5%. Also, 64 full-time psychiatric technicians received an average hourly raise of $3.16, or 21.23%.

Rep. Danny Tenenbaum, D-Missoula, questioned the reality of the immediate jeopardy status being lifted given the ongoing high vacancy rates. Meier acknowledged the difficulties but said he was optimistic the increased salaries would make a difference.

“I do think it’s realistic, certainly challenging. And I think with the recent pay increases, I think that’s one thing that will hopefully help,” Meier said.

On Monday, CMS and the Health Department agreed to enter a time-limited Systems Improvement Agreement, which extended the March 14 deadline for the hospital to meet federal standards. One of the reasons CMS proposed the agreement was the “significant access to care issues for psychiatric hospital services,” according to a CMS letter to the Health Department on Monday.

Meier expanded on the agreement between the two parties at Tuesday’s meeting.

“There’s not a lot of access outside of that for services that are offered outside of (the Montana State Hospital). And so looking big picture and long term at that, I think they wanted to work with us and try to, in addition, to just clearing (immediate jeopardy status), really try to enhance the quality of the operations at MSH so that we can improve patient care,” he said.

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