West Virginia has the oldest population in the country. In addition, West Virginians have some very unhealthy characteristics such as tobacco use, diabetes and obesity. Compounding the problem is the fact that our state continues to lose population every year thereby depleting its vital workforce. How are we ever going to meet the future health care needs of citizens?
There are many places to start, and West Virginia has initiated several positive steps, but policy makers have three critical areas to address to ensure we have a sufficient, competent workforce and a financially viable system to provide quality health care to all West Virginians. Those issues are workforce development, simplification of regulations and a long term strategy for funding the Medicaid program.
The nursing shortage is well documented. The average age of an RN is on the rise, and it has been reported that over half of the current RNs intend to retire between the years 2011 and 2020.
Governors Wise and Manchin, as well as the West Virginia Legislature, have also recognized the importance of nurses and the pending potential shortfall. In 2001 the Legislature created a study commission to address the nursing shortage in West Virginia. As a result, the Legislature created the West Virginia Center for Nursing in 2004. Through collaboration with the Center, West Virginia University School of Nursing–Charleston Division and Charleston Area Medical Center Education and Research Institute, the West Virginia Nursing Leadership Institute was created in hopes of addressing the demand for 2,500 new nurses by 2008.
While these are positive steps for addressing the professional direct care workers, RNs, LPNs and vocational nurses are only a part of the overall workforce needed for the health care delivery system. In the long term care delivery system (facility-based services and home-based services), professional direct care workers make up only 14 percent of the total workforce. Paraprofessional workers such as nursing aides, orderlies, attendants, home health aides and personal care aides make up 43 percent of the total workforce. The other 43 percent include other health care professionals like physicians, therapists, medical technicians, food service workers, environmental staff, maintenance personnel, social workers and administrative support.
Some studies have suggested that due to the aging population, Americans will actually spend more on long term care services than acute care services by the year 2015. This is one reason why we must begin to make sure that the paraprofessional workers and other professional workers are supported with the same focus being given to nursing professionals.
There are several steps that we can take to initiate and expand West Virginia’s workforce development. We must continue to explore strategies that take advantage of the workforce development monies available from the federal government. We can also initiate specialized programming within our existing educational system to train our children for career opportunities within the health care field that will give our children an incentive to stay and work in West Virginia.
In a four year period from 1996 to 2000, the national nursing pool lost 175,000 registered nurses due to retirement or death. During that time period the number of registered nurses not employed in nursing grew to 490,000. Only a few of these nurses are actually looking for employment in the nursing field. Why? That leads to the second of my three primary issues—over-burdensome regulations.
Over-regulation is a major reason for professional and paraprofessional burn-out. The most common issues associated with burn-out include workforce shortages that cause excessive hours for those who are working, and pay scale differences caused by inadequate reimbursement. I also believe that over-regulation is equally to blame. This is particularly true in the long term care profession, where the staff find it difficult to practice under the existing layers of onerous regulations that are subjectively interpreted and change seemingly every week. This causes a tremendous amount of stress and makes the profession undesirable for many physicians, registered nurses, licensed practical nurses, certified nursing assistants, therapists and other health care workers.
Many projects are underway that are focused on identifying existing barriers to our system. Governor Manchin’s Medicaid Redesign, the legislatively created West Virginia Health Information Network, the Electronic Health Record initiative spearheaded by the West Virginia Medical Institute, and parts of “A Vision Shared” project are all geared toward improving West Virginia’s health care future. While these projects are effective at identifying major issues and barriers, we need to also focus on the day-to-day problems promulgated by burdensome and conflicting licensing rules and practice acts. We must eliminate over-regulating and turf-protecting so that we can focus on patient outcomes and satisfaction surveys as quality indicator measures.
The third part of the equation is the stabilization of Medicaid funding. This has to be accomplished in two ways. First, we must control the growth of the program. Notice I said “growth” because there are two inevitable facts in West Virginia: there are going to be more people in need of assistance and the cost of providing those services is going to increase.
Medicaid Redesign is focusing on personal responsibility and creating incentives for Medicaid beneficiaries to have a stake in when and how they receive services. This is a great step toward creating a healthy society and thereby curbing future health care costs.
In addition, we need to make sure that we have Medicaid eligibility criteria supporting appropriate placement for individuals. There is a continuum of care that includes home-based services, assisted living communities and nursing homes or skilled nursing facilities. A person should not have to be nursing home eligible in order to receive assistance with home-based or assisted living services.
For the most part, individuals residing in nursing homes can not have their needs met by being cared for at home. It is a different level of need and service. For those that can be, or for those that could receive services and potentially prevent their need for a nursing facility, they should be afforded help.
That leads to the second part of helping to stabilize Medicaid funding. Earlier, I mentioned that Americans will spend more on long term care services than acute care services by 2015. Medicaid alone can not withstand the demand for services. There is simply not enough state money or taxpayers to support our aging population.
West Virginia needs to provide significant incentives for individuals to purchase long term care insurance now. The types of incentives can be tax credits, deductions or personal exemptions. The federal limit on how much of the premium can be deducted for 2007 ranges from $290 to $3,680 depending on your age.
If you purchase a policy when you are younger, then the premiums will be less expensive. In addition, most qualified long term care insurance policies cover nursing facility services, assisted living services and home-based services. Qualified policies are generally those that are approved by the state insurance commissioner and have premiums which meet the deductibility rules established by the Internal Revenue Service.
In today’s world, purchasing long term care insurance is the single best health care insurance investment for individuals. Proper policies will allow people to stay in homes or assisted living communities longer and then provide the nursing facility services as appropriate.
All three of these issues—workforce, simplification of rules and stabilization of Medicaid funding--can be addressed through the legislative process. Some changes have already been initiated, but we must continue to do more to ensure access to affordable health care in the future.