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Public Policy: The Growing Medical Crisis

COVID-19 has highlighted problems with health care staffing that began well before the pandemic

By Bob Babbage and Julie Babbage

Doctor putting on a glove to prevent coronavirus contamination

Since the beginning of the COVID-19 pandemic, news outlets have called attention to the dire hospital conditions across the country and here at home.

The fact is: Health care staffing shortages have been a problem in America for decades, particularly in rural areas. The COVID-19 pandemic has simply escalated the problem.

Kentucky’s medical personnel problems are so pervasive that lawmakers introduced legislation during the September 2021 special session, hoping to elevate the concern of hospitals and nursing homes.

Some are urging a second, brief special session. Of course, calling and setting the agenda is up to Gov. Andy Beshear.

Sen. Ralph Alvarado, R-Winchester, a physician, is pushing to allocate $81 million in ARPA (American Rescue Plan Act of 2021) funding towards recruitment and retention efforts for nurses, nurses’ aides, respiratory therapists, emergency personnel and others.

There is some question whether these funds remain available.

The General Assembly allocated over $69 million in federal resources to use in schools, businesses, hospitals and nursing homes, most likely to be used on COVID-19 testing programs.

Sen. Steve Meredith, R-Leitchfield, a former hospital CEO and current chair of the Medicaid Oversight Committee, regularly cites health care shortages and rural hospital struggles.

“We cannot overemphasize how critical infrastructure is for health care right now, especially in rural areas,” Meredith said. “The state government has never developed a comprehensive plan for staffing shortages, which it desperately needs to do.”

House Health and Family Services Chair Rep. Kim Moser, R-Taylor Mill, says any plans must include both short-term and long-term goals. “We have a fire in the house right now, and we have to put that out first, but we really need to look hard at the core of the issue.”

Alvarado and Moser believe the shortages in health care providers and support staff are multifold. The workforce is predominantly female, and many have left because of burnout and because of the lack of child care during the pandemic.

The burnout issue is all too real among medical professionals. Per Alvarado, “Doctors used to die with their boots on, and that isn’t the case anymore.” Others in the field, like nurses, can say the same.

Meredith would like to see a task force put together immediately with the principal goal of addressing recruiting efforts. “We must get to the root of the problem rather than just finding short-term solutions.”

Alvarado points to the state’s 2013 Health Care Capacity Report commissioned by then-Gov. Steve Beshear that is still relevant.

Many say Kentucky has the second-highest rates per capita in the nation for medical malpractice suits. Malpractice insurance is inherently higher as a result, increasing overall costs and reducing competition and recruitment.

Of the 11 recommendations, major points included increased and expanded Medicaid reimbursement for rural areas and technology-driven care as well as loan forgiveness and recruitment enhancements.

Many states planned in advance, including massive funding packages for recruiting and retaining providers, particularly nurses. Kentucky’s state government has yet to venture into that arena.

Hospitals received major sums of CARES Act money, but CEOs and association directors say the vast swath went to procuring PPE and other necessary equipment upgrades, not to people.

Current financial difficulties were compounded by the decision to shut down elective and outpatient procedures. The months-long elimination of surgical lines cut off the biggest source of revenue for hospitals.

Moser and Alvarado say the question is not simply whether we have enough ICU beds, but whether we have enough staffed ICU beds. The problem is not one of space, but people. The current levels routinely place us at less than 100 across the state, which is less than one bed per 120 counties.

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