From the South Bend Tribune: South Bend Tribune: Indiana nurse shortage worst in the nation

INDIANAPOLIS (AP) — Indiana's nursing homes are facing critical shortages of registered nurses and nurses aides at a time when the population is aging and requiring more care, an industry group says.

The Indiana Health Care Association says an industry survey found nursing homes in this state had the nation's highest vacancy rate for registered nurses last year, and the rate for vacant aide positions was the eighth highest in the nation.

The IHCA, which represents nearly 300 nursing homes, and the national group that it's an affiliate of, the American Health Care Association, called this week on the new Congress and the administration of President-elect Barack Obama to take steps such as education incentives and Medicaid reform that would build up the number of nurses and aides working in nursing homes.

There's a tsunami on the way" with the growing population that will need nursing home care, IHCA President Steve Smith said. "We need to be prepared, and right now, it appears we are not."

Advocates for seniors agreed with Smith on the urgent need for more nurses and aides. They said the shortages also affect other health care settings including home care and hospitals.

An AHCA survey released last month found 26.0 percent, or more than a quarter, of registered nurse positions in nursing homes were vacant last year on June 30.

The survey found that 13.7 percent of certified nurses aides slots — about one in seven — also were empty on that day. The national vacancy rate for nurses was 16.3 percent and for nurses aides, 9.5 percent.

Filling those Indiana nursing home vacancies would require more than 500 nurses and more than 2,200 aides, a report that included the survey estimated.

Smith said state and federal governments could diminish the shortage by giving nursing homes more flexibility in how they are allowed to spend Medicaid funds that pay for patients' care and through education incentives like tuition forgiveness and low-cost loans for students training to be nurses and aides.

He also said the health care standards the homes must meet are too strict. For example, two homes that had spotless records previously recently were cited for 17 problems each, and that demoralizes staff and increases turnover.

Smith said the IHCA was seeking a lawmaker to sponsor draft legislation that would give nursing homes more flexibility in how they spend Medicaid funds, a step he said would lead to better staff retention by nursing homes.

"What we're seeing over and over again is there's a direct link between quality and staffing," Smith said.

The AHCA report estimated that two-thirds of RNs in nursing homes left their jobs last year and that 93 percent of aides did.

Michelle Niemier, executive director of the advocacy group United Senior Action of Indiana, agreed nursing homes needed more RNs and aides, but said those staffs also had to have the training, supervision and consistent hours to adequately serve residents and their families.

"The number one concern of family members is the number of well qualified, well trained, well supervised staff in nursing homes," Niemier said.

June Lyle, state director of AARP, said the shortage of nurses threatens access to quality health care not only in nursing homes but also in home care, hospitals and doctors' offices. The group forecasts a shortage of 1 million nurses nationwide by 2020.

Nurses' job satisfaction also needs to improve by giving them more of a voice in how patients receive care, Lyle said.

Compounding the shortage is a diminishing number of nursing faculty members who are available to teach students, she said,

"There's a real bottleneck in that educational system for nurses," Lyle said.