The state psychiatric hospital’s heavy reliance on contract workers to make up for a lack of full-time staff is not a sustainable workforce model, state health department director Adam Meier said Tuesday.
Montana State Hospital has recently been marred by deficiencies that resulted in preventable patient deaths, spurred emergency meetings by state lawmakers and landed the facility an “immediate jeopardy” status from federal overseers. Staffing problems have long plagued the state hospital. Numbers provided by the Montana Department of Public Health and Human Services on Tuesday served as an official verification of conditions current and former staff have been raising for months, primarily regarding the exodus of permanent and long-term employees.
People are also reading…
During Tuesday’s interim legislative committee meeting, Meier said the department approved wage increases last year in an attempt to retain staff. He also said using contract staff as a crutch to provide essential services to patients with severe mental illness was going to create more issues if left unaddressed.
“It’s certainly not sustainable long term, financially or otherwise,” Meier told the committee. “Nor is it optimal for continuity of care. … We lose some of that institutional knowledge.”
The hospital has massive vacancy rates in the facility’s staff, including 72.5% of registered nurses, 62% of psychiatric aides and 54% of custodians, according to data provided by Meier.
Overall, the Warm Spring facility’s vacancy rate for permanent employees is 39.3%, roughly the same as reported by the Montana Department of Public Health and Human Services late last year. But Meier said contract staff have filled many of the gaps, putting the actual vacancy rate at 10% and allowing the hospital to continue its obligated services.
However, those contract staff, according to Meier’s figures, can earn more than twice as much as regular employees, straining the facility’s budget.
The entrance to the campus of the Montana State Hospital at Warm Springs.
A licensed practical nurse, for example, makes $27.29 per hour as a full-time employee, not including benefits, but a contract or traveling nurse hired for the same work averages at $75.48 per hour. A registered nurse who works at the state hospital full time makes $54.10 per hour, but a registered nurse on contract in Warm Springs makes $106.81.
Additional figures show the state hospital has used contract workers more and more in certain roles over the course of 2021. Contract certified nurses assistants, for example, were billed for 2,000 hours in January 2021. By December, those hours billed reached 16,000. Contracted licensed practical nurses have remained relatively stable, keeping below 2,000 hours billed over last year. The number of full-time staff, meanwhile, has been on a consistent decline from about 450 in 2019 to nearly 300 by the end of 2021.
Reaching further back, DPHHS said last year that 22 contract staff worked at the facility in 2019, compared to 136 in 2021.
“Is it realistic that we’ll ever get the (immediate jeopardy) status lifted, given these, what seem like, extreme vacancy rates?” Rep. Danny Tenenbaum, D-Missoula, asked Meier in the meeting. “It seems like there’s going to be no one left working in the state hospital pretty soon.”
Meier said he did think the hospital can realistically reach compliance once again. The department is working with the Centers for Medicare and Medicaid, which requires the hospital meet requirements in order to receive federal reimbursement dollars. To continue getting federal funding, CMS said last week it may require the hospital to bring on a third party to help manage the facility, something DPHHS began soliciting back in November.
Meier also pointed to efforts to retain staff with pay raises in June, January and another round in February. Some of those wage increases that took effect Feb. 12, according to Meier’s figures, were as high as 23% for forensic mental health technicians, 22% for custodians and 21% for psych aides. In total, 279 employees saw a bump in their paychecks last month.
After the wage increase was posted for food preparation staff, Meier said, the hospital is now seeing a strong applicant pool and he hopes to see the kitchen fully staffed soon.
“That’s not something that’s happened since at least the last three or four years,” Meier said. “So I’m hopeful that we see similar interest in those positions that also recently obtained rate increases as we get those positions posted.”
