Lack of staffing, dilapidated structures and little reimbursement for care, among other things, are pushing the Department of Health and Human Resources to rethink how it operates West Virginia’s four state-run long-term care facilities.
In a presentation to the Legislative Oversight Commission on Health and Human Resources Accountability on Monday , department Secretary Bill Crouch told legislators some form of privatization may be the best step forward for the centers and their patients.
In total, the department operates seven health care facilities across the state: one acute care hospital, two psychiatric hospitals and four long-term care facilities (Hopemont Hospital, Jackie Withrow Hospital, John Manchin Sr. Healthcare Center and Lakin Hospital).
The long-term care facilities were the focal point of Crouch’s presentation.
“These facilities have been under state operation for decades,” Crouch said. “People keep asking me, what is DHHR’s plan for here going forward, so I wanted to share some of what we’ve been discussing.”
There are 452 licensed beds between the four state-run long-term care facilities. Less than half — 224 beds — are occupied, Crouch said. Census counts are down in the private sector, as well, over the same time.
The facilities under state control, however, are referred to as “facilities of last resort,” Crouch said. Patients are “high risk.” They often take in people who private providers won’t serve.
“[The facilities] serve as a safety net for the most vulnerable, the most disadvantaged, the elderly. We take the patients who are more vulnerable and who are more difficult,” Crouch said. “[Patients] need more money and more services. We’re the facilities, where if someone can’t get placed in the private sector, it’s always been us taking these folks.”
Crouch said the first wave of the pandemic hit staffing at the hospitals hard. Staffing was a challenge before COVID-19, but the virus accelerated the issue. Crouch implemented a moratorium on admissions for the hospitals under the understanding that privately run facilities would be willing to take the state’s potential patients.
Part of this issue is due to the state offering lower wages for working at these facilities than private sector employers do. It creates “a critical manpower shortage,” Crouch said, and means higher-than-average turnover for positions necessary for the agencies to operate.
To fill these holes, the state uses temporary staffing agencies — some of the same ones that state employees are leaving for — “as a stop gap.” But they’re expensive, Crouch said, and not at all a permanent solution.
“We don’t work short, but you can’t take care of patients unless you have an adequate number of staff,” Crouch said. “That becomes more difficult with the staffing agencies.”
And despite the decrease in patients over the last year, the cost of staffing at the hospitals has exploded. In 2019, the cost of staffing the four long-term care facilities was $5.7 million. In 2021, Crouch said, that increased to $12.4 million — a near-120% increase.
Crouch said a large part of this cost increase is because of the contract staffing.
“And it’s gotten so much worse with COVID-19,” Crouch said. “I’ve heard reports of nurses being offered $45,000 for four weeks of work [with a contract agency]. We can’t match that. It’s become some kind of a bidding war and it’s very difficult to break that cycle.”
The state was looking at these issues in 2019, before the pandemic, but any progress made disappeared as the virus took hold, Crouch said.
Now, the state is stuck: It can’t afford to compete with the private sector’s wages, so it pays a hiring agency to bring in temporary workers. Those fees, though, end up costing more than the private sector rates would.
“We can’t raise our salaries that high,” Crouch said. “We can’t really do anything until we get back down to some level of normal in this pandemic.”
The staffing issues are compounded with facility issues. Jackie Withrow Hospital, in Raleigh County, is the most recently established, being built in 1927. Most were built as tuberculosis hospitals in the late 19th and early 20th century. Though all the state-run facilities have seen upgrades or add-ons, they are still out of date, Crouch said.
“Nearly all have seen remodelings and updates, but that is a band-aid fix,” Crouch said. The costs, he continues, “are an enormous liability to all state-owned and operated nursing facilities.”
And while the moratorium on new admissions has meant less potential revenue from treatments and patients over the last year, Crouch said it doesn’t really matter. There isn’t enough personnel to adequately care for more patients, enough money to pay more personnel or any significant amount of income that would come with more patients.
“The costs stay high whether we use all those beds or not,” Crouch said. “We don’t have the resources to use all the beds.”
Last year, a bill that would have shut down these care centers was introduced to the Legislature but failed to pass. Crouch said he knows state leaders want to see something change with how the facilities are managed.
Potential solutions shared Tuesday nearly all relied on some form of privatization, which Crouch said has been an option discussed since he joined the department in 2017.
“Cost reduction in operating would be one positive, but other positives could include the replacement of old facilities, better living conditions for patients and residents and competitive wage rates and benefits for workers,” Crouch said.
But it’s unclear how this would actually look.
One option is a management contract, where the state would contract a company to manage the hospitals and operations, “but sometimes that can just add to the cost of operating the system,” Crouch told lawmakers.
Another option — a mix of several others mentioned by Crouch — would require a for-profit nursing home corporation to acquire the services. This would entail selling the licenses for the beds to the private agency, but — at least temporarily — keeping the facilities.
In this kind of operation, there would eventually be construction of new facilities, Crouch said. When those open, existing patients would transfer and all operations would then go to the private sector.
Employees would no longer be state employees, meaning they could get higher pay from private agencies but could lose retirement and insurance benefits acquired through years of service to the state.
Crouch said the construction of new facilities could be an “economic development package” for any community they are built, as construction often leads to jobs for a region.
There was no time frame released for changes to the facilities, or any details shared on what, exactly, any legislation would look like to start privatization. Crouch said Department of Health and Human Resources representatives have been in talks with some companies that may be interested in assisting the state, but details of such discussions — including what companies were involved — were not shared Monday.