15 posts categorized "Health Care"

Job vacancies climb at nursing homes

Nursing homes have long struggled to hire and retain workers for a number of reasons.

For example, tending to the chronically ill or the very old can be physically and emotionally demanding. And pay is often modest, due in part to comparatively low Medicaid reimbursement for the care of low-income residents. In some cases state law contributes to low wages; in Minnesota and North Dakota, for example, residents who pay for their own care are charged the same rates as those paid by Medicaid.

Recovery from the Great Recession has made maintaining a stable workforce even harder for nursing homes. A recent survey sponsored by Care Providers of Minnesota and LeadingAge Minnesota, associations representing providers of housing and other services to the elderly and disabled, found that health care job vacancy rates in Minnesota nursing homes increased from 2013 to 2014 (see chart). Total health care job vacancies in the state’s nursing homes rose 51 percent over that period.

Nursing home job vacancies 6-30-15

Employee turnover also increased in the survey; annual turnover of registered nurses at nursing homes increased nine percentage points, to 47 percent.

Nursing homes have difficulty competing with other health care employers that pay higher wages, said Patti Cullen, CEO of Care Providers of Minnesota. “Right now registered nurses are being stolen away from nursing homes because they can earn $35,000 a year more” in hospitals, she said. Also, hospitals and clinics often offer better working conditions and career prospects.

Sources in Wisconsin and the Dakotas also said nursing homes were scrambling to hire and hold onto workers. Many operators have turned to “travel nurses”—workers provided by medical staffing agencies for temporary assignments—to fill vacancies.

Raising wages is one solution to the workforce crunch. Recent legislation in Minnesota and South Dakota increased Medicaid funding for nursing homes and assisted living facilities (which have also seen job vacancies jump) to help cover labor and other costs. But Cullen said that “we also need to move more people into the pipeline” to fill jobs not just in long-term care but elsewhere in health care, one of the district’s fastest growing industry sectors.

For much more on long-term care in the Ninth District, see the upcoming July issue of the fedgazette.


The part-time blues: White collar versus blue collar jobs

Part-time work has seen a considerable swing since the recession (see earlier Roundup post). Different types of workers also saw varying fluctuations in part-time work. Take blue collar versus white collar workers, for example.

The Current Population Survey, conducted by the U.S. Census Bureau, categorizes 11 major occupations by the color of their collar: Two are white collar and nine are blue collar (see table, at bottom). As a result, blue collar jobs currently make up a little more than 70 percent of all part-time jobs (see Chart 1).

Part-time B&W collar CH1

Roughly one-quarter of all blue collar jobs are part time, a ratio that changed modestly during the recession, but has been declining (see Chart 2). Levels of “part-time jobs for economic reasons”—a category described by the CPS as “involuntary”—are also much higher as a share of the labor force compared with white collar positions (see Chart 3).

 The share of blue collar workers at part-time jobs involuntarily rose steeply during the recession and remained quite elevated until last year, when levels began to fall quite rapidly and are now near prerecession levels. A similar pattern exists for the share of white collar workers who are part time involuntarily, although this share is still somewhat elevated.

Look for future fedgazette Roundup blog posts on more part-time job trends in Ninth District states, as well as an in-depth look at Ninth District job growth since the recession in the July issue of the fedgazette.

Part-time B&W collar CH2-3
   Part-time B&W collar TABLE


The waiting game: Wait times at VA health centers vary across Ninth District states

Going to the doctor is not always fun. But waiting for the doctor can be worse. Much attention has been paid to wait times for military veterans seeking care at Department of Veterans Affairs (VA) medical centers across the country, and data from the VA show that wait times vary significantly among VA health care systems in Ninth District states.

For example, the percentage of pending appointments that are scheduled more than 30 days after the preferred date runs as low as 1 percent (Fargo, N.D.) to 10 percent (Milwaukee, Wis.), according to VA data released this month for appointments through March 15, 2015. The likelihood of waiting also appears unrelated to volume; for example, the Minneapolis office, which had 73,000 pending appointments at 11 health centers across the state, has a lower average wait rate than Milwaukee, which has 58,000 appointments on the books at six facilities.

Field facilities within a specific VA district also vary considerably. For example, at Montana’s busiest VA facility (Fort Harrison), nearly 16 percent of appointments are scheduled more than 30 days past the preferred date, while the rate is 4.4 percent in Billings. But again, volume isn’t necessarily the culprit. The Iron Mountain district serves the Upper Peninsula of Michigan. Its busiest facility (in Iron Mountain) had a 30-day wait rate of 5.7 percent, while the Marquette facility—with one-quarter of the appointments—had a wait rate of 13.2 percent.

VA wait times -- 4-9-15

Ad hoc survey: Ninth District businesses plan to ramp up hiring, increase starting pay

The Ninth District economy is in growth mode and employment is expected to increase, based on a recent poll of 140 business contacts from around the district (see methodology below).

Businesses are expecting to expand, with 46 percent of respondents planning to increase employment at their firms and 58 percent of these firms citing anticipated high sales growth as the most important factor behind increased employment. Only 3 percent plan to decrease employment. In the same survey a year ago, 41 percent planned to increase employment and 9 percent planned to cut jobs (see chart).

Other important factors cited for new hiring were overworked staff, the need for additional skills and improved financial condition of firms. The vast majority of respondents plan to use current employee referrals, word of mouth and advertising to get new employees. Forty-eight percent plan to use a recruiting firm, which is up from 22 percent of respondents in last year’s poll. Twenty-seven percent of respondents also plan to raise starting pay compared with only 8 percent last year.

Feb ad hoc survey Ch1+meth -- 2-13-15

Methodology: On Dec. 1, 2014, the Minneapolis Fed emailed a web-based survey to about 600 Beige Book contacts from around the Ninth District. By Feb. 12, 140 contacts had filled out the survey. The respondents come from a variety of industries (see table).

The aches and pains of working-age disability

Since the 1980s, working-age disability has been rising, and particularly over the past decade. Many disorders can qualify a person for one of two major federal disability programs: Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

However, recipients are increasingly qualifying for these programs because of either mental disorders or conditions related to the musculoskeletal system or connective tissues, which covers a variety of muscle, back and joint disorders like arthritis, back pain, tendonitis and herniated discs.

In Ninth District states, the most common disability diagnosis (at 42 percent) for SSDI recipients is a mental disorder, such as anxiety, post-traumatic stress disorder, depression or bipolar disorder (see Chart 1). While recipient growth in this category exceeded 50 percent from 2003 to 2013, it has leveled off in recent years.

The fastest growing diagnosis involves conditions related to the musculoskeletal system and connective tissue. This category covered about one in four SSDI recipients in 2013; total recipients have doubled over the past decade. Growth in these two major diagnosis categories has also been faster in the Ninth District than in the nation over the past decade (see Chart 2).

For much more on disability trends in the Ninth District, see the January cover of the fedgazette.

Dulguun Batbold, research analyst, contributed data to this article.

Disability diagnosis CH1-2 -- 2-10-15

Health insurance premiums vary widely for state workers

Health insurance for employees is a major expense for state governments, but costs vary widely across the nation and Ninth District, particularly for premiums involving workers and their families, according to a new report this week by the Pew Charitable Trusts.

Monthly, employer-paid premiums for employees (only) are relatively similar among Ninth District states, from a low of $427 in North Dakota to a high of $587 in Wisconsin, which is also the only state whose employees share in the premium cost, at $97 per worker. Montana state employees, on average, receive a small credit of $21, according to Pew.

Much bigger differences occur in state health care coverage for workers and their dependents. South Dakota actually spends slightly less (per month, per worker) on family coverage ($493) than on single coverage ($496), and the state also requires a considerable cost share of $183. State-based costs for families in North Dakota are twice as high as in its southern neighbor, and South Dakota workers pay nothing. Premium costs in Minnesota and Wisconsin are higher still. With a total monthly premium of almost $1,700, Wisconsin has the second-highest health care premiums for state workers with dependents in the country, behind only New Hampshire.

State helath care premiums -- 8-13-14

March madness: ACA enrollments racing to sign-up goal

The March 31st deadline to sign-up for private health insurance plans as part of the Affordable Care Act is fast approaching, and enrollments in some states are sprinting toward their projected goals while others are lagging, according to data released last week by the U.S. Department of Health and Human Services.

As of March 1, enrollments in Michigan and Wisconsin are at 90 percent of enrollments projected by HHS before the new law’s launch (see chart). In contrast, fewer than 7,000 people have enrolled in South Dakota, or just 36 percent of its 19,000 projection. Minnesota is the only district state that constructed its own health plan exchange (all others are using the federal healthcare.gov exchange). Enrollment in private plans to date through the MNsure exchange was just 48 percent of the goal of 67,000.

States and the federal government are also keeping a close eye on the number and proportion of young people signing up. For health insurance markets to work efficiently, the number of younger (and healthier, actuarially speaking) enrollees has to balance out the number of older, less healthy enrollees. It was originally estimated that 18 to 34 year olds would make up 35 to 40 percent of all enrollees. So far, it’s just 25 percent, and has remained fairly consistent in monthly reports. Among district states, only about one in five Wisconsin enrollees are in this young age bracket, while South Dakota has one of the highest rates, at 29 percent.

ACA March update -- 3-17-14

The little independent pharmacies that could (with a little help)

With all that booming going on in Williston and the surrounding Bakken region, it’s enough to give everyone a tension headache. Good thing you can pop into the Walmart pharmacy for some relief.

What’s that? No Walmart pharmacy? OK, fine, a Walgreens will do just fine. None of those either?

Turns out that all the oil activity in the Bakken region—and strong overall growth across the state—has been a boon to independent pharmacies, running against the nationwide trend of pharmacy growth mostly among pharmacy chains and supermarket and mass merchant locations like Walmart. In 2007, North Dakota had 80 pharmacies; by 2013, that number had almost doubled to 151 pharmacies, according to the National Community Pharmacists Association, which publishes an annual digest of pharmacy statistics.

But the truly notable part of this pharmacy growth in North Dakota is that it came entirely from independent pharmacies (see chart). The number of pharmacy chain stores dropped by one over this period, and there are no supermarket or mass merchant pharmacies to speak of in the state—in any year. Meanwhile, the number of independent pharmacies grew by almost 150 percent.

This seeming economic anomaly is, in fact, born from “a 40-year-old law [that] tilts heavily toward independent community pharmacies,” according to the NCPA, in email correspondence. In 1964, the state passed a law requiring that majority ownership of a pharmacy be by a licensed pharmacist. Existing chain stores were grandfathered in, but the NCPA noted that “this law prevents national chains from moving in” and has withstood referendums and legal challenges. “So the natural rush of chain pharmacies like CVS and Walgreens that usually accompanies a job surge hasn’t occurred.”

ND pharmacies -- 2-28-14

More evidence that businesses expect to grow, increase hiring

Signs are upbeat that the Ninth District economy will continue to grow, according to a recent poll of more than 300 business contacts from across the district (see methodology below).

For starters, 40 percent plan to increase employment at their firms, and nearly three-quarters of these firms cited expected high sales growth as the most important factor. Only 7 percent plan to decrease employment. In the same survey a year ago, 38 percent planned to increase employment and 10 percent planned to cut jobs.

Other important factors cited for new hiring were overworked staff, improved financial condition of firms and the need for additional skills. The majority of respondents plan to use word of mouth and advertising to get new employees. Twenty-eight percent plan to use a recruiting firm, and surprisingly few (9 percent) plan to raise starting pay.

For those respondents not planning to hire additional people this year, most expected low growth sales and a desire to keep operating costs low. Many reported difficulty finding skilled candidates. Though fiscal policy developments were not a factor for most respondents, 35 percent said they had a detrimental effect on hiring and 4 percent said they would increase hiring plans.

The survey also asked about wages and benefits; 36 percent expected wage growth of 2.5 percent or more, and a similar amount expected positive wage growth of less than 2.5 percent (see Chart 1). Respondents generally believed benefit increases would be larger than those for wages (see Chart 2).

  Ad hoc survey Ch 1-2 -- 2-5-13

Methodology: On Jan. 15, the Minneapolis Fed invited, via email, about 1,000 Beige Book contacts from across the Ninth District to answer the special question in a web-based survey. By Jan. 31, 303 contacts had filled out the survey. The respondents come from a variety of industries (see table below).

Ad hoc survey METHOD TABLE -- 2-5-13

Beige Book, Minneapolis: Ninth District economy slowly improving

The Ninth District economy expanded modestly during late summer and early fall, according the most recent Beige Book released this week by the Federal Reserve Bank of Minneapolis.

Each of the 12 Federal Reserve district banks drafts a similar report, which in sum are a summary of regional economic conditions across the country, in preparation for the Oct. 23-24 Federal Open Market Committee meeting, where interest rates and other monetary policy issues are decided.

In the Ninth District, improved activity was seen in construction and real estate, consumer spending, tourism and professional services. Energy and mining continued to perform at high levels, while agriculture varied widely, with crop farmers generally in better condition than animal producers. On the softer side, manufacturing activity slowed in late summer, and wage increases remained subdued, although stronger increases were reported in some areas. But labor markets tightened somewhat, and price increases were generally modest.

For those interested in other regional, national or historical Beige Book reports on economic conditions, the Minneapolis Fed offers everything in one spot.