SurveyofHealthCareEmployersinArizona:HomeHealthAgencies,2015
July15,2016Preparedby:LelaChuJoanneSpetz,PhDUniversityofCalifornia,SanFrancisco 3333CaliforniaStreet,Suite265SanFrancisco,CA94118ThisstudyissupportedbyVitalystHealthFoundationofArizonaandtheCityofPhoenix.AnyviewspresentedinthisreportdonotnecessarilyreflecttheopinionsorpositionsofVitalystHealthFoundationandtheCityofPhoenix.
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PREFACE
SurveyBackgroundThisreportsummarizesfindingsfromasurveyofhomehealthagencyemployersinArizonaconductedfromsummertofallof2015.ThisisthefirstsurveyofhomehealthagencyemployersinArizonaandprovidesanopportunitytoevaluateoveralldemandforhealthcareworkersinthestate.Thesurveyalsocollectedinformationspecifictothehiringandtrainingofnewlygraduatednursesbecausetheyareatparticularriskforunemploymentduringaweaklabormarket.ThedataobtainedinthissurveyrevealtheregionalvariationinthedemandforhealthcareworkersacrossArizona.
SummaryofFindingsTheSurveyofHealthCareEmployersinArizona:HomeHealthAgencies,2015,foundthatthereisaperceptionofshortageformanyoccupations,withthegreatestconcernregardingphysicalandoccupationaltherapists,physicalandoccupationaltherapyassistants,respiratorytherapists,registerednurses,andsocialworkers.Vacancyrateswereabove15percentforstaffregisterednurses(RNs),occupationaltherapists,occupationaltherapyassistants,respiratorytherapists,andsocialworkers.Demandwasmorebalancedwithsupplyfornursepractitioners,homehealthaides,andpersonalcareaides.Ruralagenciesreportedmoresevereshortagesthanurbanagenciesformostoccupations.
OverhalfofhomehealthagenciesreportedthatemploymentofstaffRNshasincreasedoverthepastyear,andnearlyhalfreportedincreasedemploymentoflicensedpracticalnurses(LPNs).Nearlyone-quarterreducedemploymentofnursepractitioners(NPs).Nearly40percentindicatedtheyhadcreatednewjobclassificationsinthepastyear,mostoftenrelatedtocarecoordinationandclinicaldocumentationspecialists.
MosthomehealthagenciesprefertohireRNswithprioremploymentexperienceandwithabachelor’sdegree.One-quarterindicatedapreferenceforRNswhocanspeakasecondlanguage,withSpanishmostoftenindicatedasthepreferredlanguage.Forty-onepercentofagenciesofferahighersalarytoRNswhoholdabachelor’sdegree,and41percentofferadifferentialtoRNswithaspecialtycertification.
Nearly40percentofagenciesoffertuitionreimbursementtostaffwhoareworkingtowardadditionaldegreesorcertifications,withmostofferingunder$3000peryear.
Nearlyallhomehealthagenciesindicatedtheyexpecttoincreaseemploymentinalloccupationsoverthenextthreeyears,althoughnearly35percentplantoreduceemploymentofnursepractitioners.Morethan30percentofhomehealthagenciesanticipatethecreationofnewRN-relatedjobclassesinthenexttwoyears,mostoftenrelatedtocarecoordinationandcasemanagement.Homehealthagenciesexpressedconcernthatfallingreimbursementlevels,potentialstatebudgetcutstoMedicaid,andthebehavioralneedsoftheirpatientscouldimpacttheadequacyoftheirworkforce.
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©2016 Vitalyst Health Foundation. Find the full report here: http://goo.gl/GzlALq
The University of California, San Francisco conducted the Survey of Health Care Employers in Arizona: Home Health Agencies, 2015 in the summer and fall of 2015. The survey elicited 25 unique responses, representing 11.4% of the total number of home health agencies in Arizona. Yuma, Gila, and Pinal Counties were not represented in this survey, since fewer than two responses were obtained for these counties. Overall survey results indicate:
Positions with the MOST CONSISTENT reports of high demand include:
• Occupational Therapists• Physical Therapists• Occupational Therapy Assistants
Supply and demand were BALANCED for Licensed Practical Nurses and Home Health Aides.
RURAL agencies reported higher demand for most positions compared to URBAN agencies, but less than urban demand for Personal Care Aides.
of agencies DID NOT create new job classifications in the last year
ANTICIPATE CREATING NEW jobs within the next three years, related to care coordination and case management.
Agencies greatest concerns regarding the adequacy of their workforce were about:
• the impact of falling reimbursement levels• potential state budget cuts to Medicaid• how to manage the behavioral needs of their patients
Respondents report a MODERATE TO HIGH demand for
• Registered Nurses – Staff• Registered Nurses – Managerial• Licensed Practical Nurses• Home Health Aides• Certified Nursing Assistants
DEMAND for MEDICAL STAFF
63%
30%
$
VACANCY RATES
Occupational Therapists, Physical Therapists, Occupational Therapy Assistants, Registered Nurses – StaffRegistered Nurses – Managerial, Respiratory TherapistsLicensed Practical Nurses, Certified Nursing Assistants, Physical Therapy Assistants, Social WorkersHome Health AidesPersonal Care Aides*, Nurse Practitioners
LABOR MARKET DEMAND FOR LONG-TERM CARE FACILITIES IN MARICOPA COUNTY
HIGH DEMAND:DIFFICULT TO FILL OPEN POSITIONS
DEMAND IS IN BALANCE WITH SUPPLY
DEMAND IS MUCH LESS THAN SUPPLY
* Indicates low response rates from long-term care employers regarding these positions.
CONCERNS for HOME HEALTH AGENCIES
RURAL AND URBAN AGENCIES
Arizona Healthcare WorkforceHome Health Agencies, 2015
Positions with over 10% vacancy rate:• Registered Nurses – Managerial• Certified Nursing Assistants• Personal Care Aides• Physical Therapy Assistants• Occupational Therapists• Social Workers
Positions with over 20% vacancy rate:• Occupational Therapy Assistants• Respiratory Therapists• Staff Registered Nurses
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TABLEOFCONTENTS
PREFACE.......................................................................................................................................................2
SurveyBackground.........................................................................................................................................2
SummaryofFindings.......................................................................................................................................2
VisualSummary..............................................................................................................................................3
LISTOFTABLES.............................................................................................................................................5
LISTOFFIGURES...........................................................................................................................................6
BACKGROUND:HEALTHWORKERDEMANDINARIZONA............................................................................7
SurveyParticipationandDataAnalysis...........................................................................................................9
FINDINGS....................................................................................................................................................11
PerceptionofLaborMarketConditions........................................................................................................11
CurrentEmploymentofStaff........................................................................................................................20
CurrentVacancies.........................................................................................................................................20
ChangesExperiencedinthePastYear..........................................................................................................21
RequirementsforRNEmployment...............................................................................................................23
ProfessionalCompetencyGaps....................................................................................................................26
ClinicalResidencyProgramsforNewRNGraduates....................................................................................26
EmploymentExpectationsfortheNextYear................................................................................................26
CONCLUSIONS............................................................................................................................................31
ACKNOWLEDGEMENTS..............................................................................................................................32
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LISTOFTABLES
Table1.Geographicregionsandthecountiestheyrepresent,2015..........................................................9
Table2.PerceptionoflabormarketdemandbyhomehealthagenciesinArizona,2015........................13
Table3.Numberofcurrentstaff(headcount)byposition,asofMay1,2015..........................................20
Table4.Vacancyratesbyposition,May1,2015.......................................................................................21
Table5.Changesinemploymentinthepastyear,byposition,2015........................................................22
Table6.OrganizationdifferentiatesRNsalariesbydegreeoradvancedcertification,2015....................25
Table7.TuitionreimbursementbenefitsperRNperyear,2015...............................................................25
Table8.Orientation/onboardingprogramforrecenthires,2015.............................................................26
Table9.ExpectationsforRNemploymentinthenextthreeyears,2015..................................................28
Table10.Plannednewjobclassificationsinthenexttwoyears,2015.....................................................28
Table11.Impactonadequacyonhospital’sworkforce,2015...................................................................30
AppendixTable1.Labormarketdemandbygeographicregion,2015.....................................................33
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LISTOFFIGURES
Figure1.Distributionofrespondinghomehealthagenciesvs.homehealthagenciesinArizona,2015..10
Figure2.Distributionofrespondinghomehealthagenciesvs.homehealthagenciesinArizona,byrural/non-ruralgeographiclocation,2015.................................................................................................11
Figure3.PerceptionoflabormarketdemandbyhomehealthagenciesinArizona,2015.......................12
Figure4.Averagerankingofoveralllabormarketdemandbygeographicregion,2015..........................15
Figure5.Averagerankingofoveralllabormarketdemandbygeographicregion,2015..........................15
Figure6.Averagerankingofoveralllabormarketdemandbygeographicregion,2015..........................16
Figure7.Averagerankingofoveralllabormarketdemandbygeographicregion,2015..........................16
Figure8.Averagerankingoflabormarketdemandbygeography,2015..................................................18
Figure9.Averagerankingoflabormarketdemandbygeography,2015..................................................18
Figure10.Averagerankingoflabormarketdemandbygeography,2015................................................19
Figure11.Averagerankingoflabormarketdemandbygeography,2015................................................19
Figure12.Vacancyratesbyposition,May1,2015....................................................................................21
Figure13.Changesinemploymentinthepastyear,byposition,2015....................................................22
Figure14.Creationofnewjobclassificationsinthepastyear,2015........................................................23
Figure15.Requirementsforregisterednursingemployment,2015.........................................................24
Figure16.CurrentlyemployedBSN-preparedregisterednurses,2015....................................................24
Figure17.Supportforstaffworkingtowarddegreesorcertification,2015..............................................25
Figure18.Expectationsforemploymentinthenextthreeyears,2015....................................................27
Figure19.Impactonadequacyonhospital’sworkforce,2015..................................................................29
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BACKGROUND:HEALTHWORKERDEMANDINARIZONA
Arizona,alongwiththerestofthenation,experiencedadeepeconomicrecessionstartinginDecember2007andasloweconomicrecoverysincemid-2009.Whilethestate’seconomyhasbeenrecovering,therehavebeensignificantchangesinhealthcarefinancinganddelivery.ThestaterestoredandexpandedMedicaidcoverage,andtheimplementationoftheAffordableCareAct(ACA)of2010expandedprivatehealthinsuranceaccesstothousandsinthestate.TheACAcontainsprovisionsthatarespurringanincreasedemphasisontheintegrationofcare,providinghigh-valuecare,andconsideringpopulationhealthbroadly.Inaddition,Arizonafacesanagingpopulation,withincreasingratesofchronicconditionsanddisabilities.1
Thesefactorsaredrivingagrowthindemandforhealthcareworkersacrossthestate.Overthepastdecade,employmentgrewinallofthehealthoccupationsinArizona,from75,490in2004to135,070in2013.2Inhomehealthagencies,nursingpersonnelplayacentralroleinthedeliveryofservices.Thesenursingpersonnelincluderegisterednurses,licensedpracticalnurses,certifiednursingassistants,homehealthaides,andpersonalcareaides.NursingshortagesareasignificantconcernforArizona.TheU.S.BureauofHealthWorkforce(BHW)projectsthatArizonawillneed87,200registerednurses(RNs)by2025,butsupplywillbeonly59,100RNs,producingashortfallof32percent.BHWalsoforecastsashortfallof9,590licensedpracticalnurses,whichisabout50percentofanticipateddemand.3Thisshortfallisalarming,particularlysincegraduationsfromArizona’sRNeducationprogramsgrew166percentfrom2002to2012.4
About47,000newjobsareexpectedinthealliedhealthprofessionsbetween2013and2020,withthegreatestgrowthprojectedforpersonalcareaides,forwhomprojecteddemandwillrisefrom21,760in2013to43,967in2020.5TheAffordableCareAct’sprovisionsalsoareexpectedtospurgrowthinemergingoccupationsthatinteractwithhomehealthcare,suchashealthandtransitioncoaches,communityhealthworkers,andintegratedcarecasemanagers.6
ThechallengeofmeetinganticipateddemandforhealthcareworkersismademorecomplexbythesignificantgeographicvariationfoundinArizona.ThestatehasoneofthelargestmetropolitanareasintheUnitedStates,aswellassomeofthemostruralareasinthecountry.7Thenumbersofphysicians,
1Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.2DatafromtheArizonaDepartmentofAdministration,reportedinIrvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.3BureauofHealthWorkforce,HealthResourcesandServicesAdministration,U.S.DepartmentofHealthandHumanServices.TheFutureoftheNursingWorkforce:NationalandState-LevelProjections,2012-2025.Rockville,MD:U.S.DepartmentofHealthandHumanServices.December2014.4Randolph,PamelaK.ArizonaStateBoardofNursingSummaryandAnalysisofAnnualReportsfromArizonaNursingEducationProgramsCalendarYear2012.ArizonaStateBoardofNursing.2012.5Irvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.6Irvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.7Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.
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physicianassistants,nursepractitioners,RNs,andpharmacistsper100,000populationaresubstantiallyhigherinurbansettingsofArizonathanruralsettings.8
TounderstandtheimpactofArizona’sagingpopulation,growinginsurancecoverage,andchangingdeliverysystemoncurrentandfutureneedsforhealthcareworkers,theVitalystHealthFoundationandtheCityofPhoenixcommissionedtheUniversityofCalifornia,SanFrancisco,tosurveyhospitals,communityhealthcenters,long-termcarefacilities,andhomehealthagenciesinArizona.Separatesurveysweresenttoeachtypeofhealthcaredeliveryorganization,includingquestionsaboutemployment,vacancies,perceptionsofthelabormarket,anticipatedchangesindemand,andreasonsforfuturechanges.Together,thesesurveysaredesignedtodevelopanaccurateandup-to-dateunderstandingofthedemandforhealthcareworkersinArizona.
8Tabor,Joe,NickJennings,LindsayKohler,BillDegnan,HowardEng,DougCampos-Outcalt,andDanDerksen.ArizonaCenterforRuralHealth2015SupplyandDemandStudyofArizonaHealthPractitionersandProfessionals.Tucson,AZ:UniversityofArizona.February2016.
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SURVEYMETHODS
TheSurveyofHealthCareEmployersinArizona:HomeHealthAgencieswasoneoffoursurveyinstrumentsbasedonthequestionnaireusedbytheUniversityofCalifornia,SanFrancisco(UCSF)intheSurveyofNurseEmployers.WithinputfromanAdvisoryCommitteeconvenedbyVitalystHealthFoundationandtheCityofPhoenix,asurveyinstrumentwasdesignedforeachsettingtomeettheresearchgoalsoftheFoundation,andtounderstandthecurrentandfuturehiringneedsofhealthcareemployersinArizona,includinghospitals,homehealthagencies,communityclinics,andlong-termcarefacilities.ThesurveysweredesignedtoprovideasnapshotofthecurrentworkforceinArizona,andthechallengesoftraining,recruiting,andretaininganadequateworkforce.TheSurveyofHealthCareEmployersinArizona:HomeHealthAgencieswasstructuredforhumanresourcesdirectorsinhomehealthagencysettingstoprovidedataonstaffing,includingcurrentheadcountsandvacancies,aswellastheirperceptionsofthelabormarket,expectationsforhiring,andthecharacteristicsoftheirnewRNgraduateresidencyprograms.
ThesurveywaspostedonlinefollowingapprovalbytheUCSFCommitteeonHumanResearch.SurveyemailsweresenttoallhumanresourcesdirectorsprovidedbytheVitalystHealthFoundationandtheCityofPhoenix.TheinvitationfromUCSFincludedalinktotheonlineversionofthesurvey,aswellasafillable-PDFformthatcouldbecompletedbytherespondentandreturnedtoUCSFviaemailorfax.Facilitieswerecontactedwithfollow-upemailsandtelephonecalls,bothbyUCSFandmembersoftheAdvisoryCommittee,toencourageparticipation.
SurveyParticipationandDataAnalysis TheSurveyofHealthCareEmployersinArizona:HomeHealthAgencieselicited25uniqueresponses.Thesetotalsrepresentapproximately11.4percentofthetotalnumberoflicensedhomehealthagenciesinArizona.9
Throughoutthereportweprovidethenumberoffacilityresponses(N)representedbythestatisticsintablesandfigures.CertaindataareusedtodescribedifferencesinlabormarketconditionsacrossgeographicregionsofArizona.Table1belowliststheregionsusedinthisreportandthecountieseachregionrepresents.
Table1.Geographicregionsandthecountiestheyrepresent,2015Region Counties
Phoenix MaricopaTucson PimaNorthernArizona Apache,Coconino,Navajo,YavapaiEastofPhoenix Pinal,GilaWesternArizona YumaNorth-WesternArizona Mohave,LaPazSouthernArizona SantaCruz,Cochise,Graham,Greenlee
9HomehealthagencieswereidentifiedusingtheArizonaDepartmentofHealthServiceshospitallistingdatabase.
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Figure1comparesthegeographicdistributionofhomehealthagenciesthatrespondedtotheUCSFsurveywiththedistributionofhomehealthagenciesacrossthegeographicregionsusedinthisreport.IntheUCSFsurvey,homehealthagenciesinPhoenixareunderrepresented,whilehomehealthagenciesintheTucson,North-WesternArizona,andSouthernArizonaregionsareoverrepresented.BecausetherewasonlyonerespondentintheEastofPhoenix,wedonotreportdisaggregateddataforthisregion.WesternArizonaisnotrepresentedinthedata.
Figure1.Distributionofrespondinghomehealthagenciesvs.homehealthagenciesinArizona,2015
Note:Percentagesmaynotsumto100%duetorounding
Figure2comparesthedistributionofsurveyrespondentswithhome-healthagenciesinthestatebasedonwhetherornotthegeographiclocationofthefacilityisconsideredrural.10Ruralfacilitiesaresomewhatoverrepresentedinthedata.
10Theruralvs.non-ruralstatusofafacilitywasdeterminedusingthe2010Rural-UrbanCommutingAreacodesandthehospital’szipcode.Formoreinformationsee:http://depts.washington.edu/uwruca/
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Figure2.Distributionofrespondinghomehealthagenciesvs.homehealthagenciesinArizona,byrural/non-ruralgeographiclocation,2015
FINDINGS
PerceptionofLaborMarketConditionsHomehealthagencieswereaskedtoreporttheirperceptionsoflabormarketconditionsforhomehealthagencystaffintheirregion,usingarankorderscaleof1to5.Ascoreof“1”indicatedthatdemandforstaffwasmuchlessthantheavailablesupply,whileascoreof“5”indicatedhighdemandforstaffanddifficultyfillingopenpositions.Figure3andTable2comparethereportedresultsofoveralllabormarketconditionsforhomehealthagencystaffinfall2015.
Approximately29percentofhomehealthagenciesreportedaperceptionofhighdemandforstaffRNs(difficulttofillopenpositions),and10percentofhomehealthagenciesreportedthesameforRNsinotherroles(management,carecoordination,utilizationreview,etc.).Otherpositionswithreportedhighdemandincludeoccupationaltherapists(63.2%),physicaltherapists(61.9%),andoccupationaltherapyassistants(44.4%).
Moderatedemand,withsomedifficultyfillingpositions,wasreportedbyArizonahomehealthagenciesforthefollowingpositions:RNsinotherroles(60%),staffRNs(54.2%),licensedpracticalnurses(50%),homehealthaides(50%)andcertifiednursingassistants(50%).
Supplywasoftenreportedtobeinbalancewithdemandforlicensedpracticalnurses(44.4%)andhomehealthaides/assistants(42.9%).
Fewpositionswerereportedashavingdemandlessthanormuchlessthanthesupplyavailable;therolesreportedbyhomehealthagenciesasbeinginlessdemandinclude:personalcareaides(33.3%),physicaltherapyassistants(14.3%),andoccupationaltherapyassistants(11.1%).Whendemandwasreportedasmuchlessthansupplyforaposition,itwasonlybyonehomehealthagencyforeach
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position.Thesepositionswerephysicaltherapyassistants(7.1%),occupationaltherapists(5.3%)andphysicaltherapists(4.8%).
Figure3.PerceptionoflabormarketdemandbyhomehealthagenciesinArizona,2015
Figures4through7showtheaveragerankingofoveralllabormarketconditionsforallsurveyedpositionsbyregion.TherewasasmallnumberofindividualrespondentsfromtheNorthernArizona,North-WestArizona,EastofPhoenix,andSouthernArizonaregions.Thedatafromtheseregionswerecombined,anddisplayedas“RestofArizona.”Thedatapresentedaretheaveragescoresforeachtypeofworker,witha1indicatinglowdemandrelativetosupply,anda5indicatinghighdemandrelativetosupply.Ascoreof3indicatesabalancedlabormarket.AppendixTable1presentsthedistributionofhomehealthagenciesineachregionaccordingtohowtheycharacterizedlabormarketsforhomehealthagencystaffin2015.
DemandforstaffRNswasreportedtobegreaterthansupplyinallregions(Figure4).ThedemandforstaffRNswassimilaracrosstheseregions,accordingtotheHomehealthagencyratings,asweretheratingsfornon-staffRNs.Demandfornon-staffRNswasreportedtobegreaterthansupply,buttheshortagedoesnotappeartobeasgreatforstaffRNs.DemandforNPswasgreaterthansupplyinPhoenix.RespondentsinTucsondidnotreportregardingtheNPlabormarket.IntherestofArizona,theshortageofNPswasreportedtobenotasgreatasinPhoenix.
0% 20% 40% 60% 80% 100%
StaffRNs
RNsinotherroles(management,…
NursePractitioners(NP)
LicensedPracticalNurses(LPN)
Certifiednursingassistants
Homehealthaides/assistants
Personalcareaides
PhysicalTherapists
PhysicalTherapyAssistants
OccupationalTherapists
OccupationalTherapyAssistants
RespiratoryTherapists
SocialWorkers(LCSW)
Highdemand:Muchdifficultyfillingopenpositions
Somedifficultyfillingopenpositions
Demandinbalancewithsupply
Demandislessthansupply
Demandismuchlessthansupply
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Table2.PerceptionoflabormarketdemandbyhomehealthagenciesinArizona,2015PerceptionoflabormarketdemandinArizona,2015
High
demand
Somedifficulty
fillingpositions
Demandisin
balancewith
supply
Demandisless
thansupply
Demandismuch
lessthansupply Responses
Description # % # % # % # % # % #
StaffRNs 7 29.2 13 54.2 4 16.7 0 0.0 0 0.0 24
RNsinotherroles(management,
carecoordination,utilizationreview,
etc.)
2 10.0 12 60.0 5 25.0 1 5.0 0 0.0 20
NursePractitioners(NP) 0 0.0 1 50.0 1 50.0 0 0.0 0 0.0 2
LicensedPracticalNurses(LPN) 1 5.6 9 50.0 8 44.4 0 0.0 0 0.0 18
Certifiednursingassistants 2 10.0 10 50.0 7 35.0 1 5.0 0 0.0 20
Homehealthaides/assistants 0 0.0 7 50.0 6 42.9 1 7.1 0 0.0 14
Personalcareaides 0 0.0 2 33.3 2 33.3 2 33.3 0 0.0 6
PhysicalTherapists 13 61.9 4 19.0 3 14.3 0 0.0 1 4.8 21
PhysicalTherapyAssistants 4 28.6 6 42.9 1 7.1 2 14.3 1 7.1 14
OccupationalTherapists 12 63.2 4 21.1 1 5.3 1 5.3 1 5.3 19
OccupationalTherapyAssistants 4 44.4 4 44.4 0 0.0 1 11.1 0 0.0 9
RespiratoryTherapists 1 33.3 1 33.3 1 33.3 0 0.0 0 0.0 3
SocialWorkers(LCSW) 6 31.6 5 26.3 7 36.8 1 5.3 0 0.0 19
Note:percentagesmaynotsumto100%duetorounding.
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AsseeninFigure5,homehealthagenciesinTucsonandtherestofArizonareportedthatdemandwasgreaterthansupplyforLPNs;theshortageofLPNsappearslesssevereinPhoenix.Demandwashighrelativetosupplyforcertifiednursingassistants,withlittlevariationacrossregions.Demandforhomehealthaidesandassistantsvariednotablyacrossthestate,withagenciesoutsidePhoenixandTucsongenerallyreportingashortage,whileagenciesinTucsonreportedarelativelybalancedlabormarket.
HomehealthagenciesreportedthatthelabormarketforpersonalcareaideswasbalancedinPhoenixandTucson,andthattherewasasurplusofpersonalcareaidesintherestofArizona(Figure6).Demandforphysicaltherapistswasreportedtobegreaterthansupplyinallregionsofthestate,withthegreatestshortagereportedinPhoenix.Thelabormarketforphysicaltherapyassistantsappearstovarybyregion,witharelativelybalancedlabormarketinPhoenix,someshortageinTucson,andanotableshortageintherestofthestate.
AsseeninFigure7,asubstantialshortageofoccupationaltherapistswasreportedbyhomehealthagenciesacrossArizona.ShortagesofoccupationaltherapyassistantswerealsoreportedforTucsonandregionsoutsideTucsonandPhoenix,whilethemarketwasrelativelybalancedinPhoenix.DemandwasgreaterthansupplyforrespiratorytherapiststhroughoutArizona.AslightshortageofsocialworkerswasindicatedforPhoenixandTucson,whileasubstantialshortageofsocialworkerswasreportedfortherestofArizona.
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Figure4.Averagerankingofoveralllabormarketdemandbygeographicregion,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicateagreatersurplus).
Figure5.Averagerankingofoveralllabormarketdemandbygeographicregion,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicateagreatersurplus).
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Figure6.Averagerankingofoveralllabormarketdemandbygeographicregion,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicateagreatersurplus).
Figure7.Averagerankingofoveralllabormarketdemandbygeographicregion,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicateagreatersurplus).
3.3
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Figures8through11compareaveragedemandforhomehealthagencystaffbasedonwhetherornotthehomehealthagencyislocatedinageographicallyruralarea.Figure8presentsdataforRNsandNPs.ThedatasuggeststhatruralhomehealthagenciesfacegreatershortagesofRNs,bothinstaffandotherroles.ThelabormarketforNPswasbalancedinruralareas;meanwhile,onaverage,thedemandforNPswasgreaterthansupplyinurbanareas.
Figure9presentsdataforLPNsandassistants.RuralagenciesreportedthatdemandwasgreaterthansupplyforLPNsandcertifiednursingassistants,andsomewhatgreaterthansupplyforhomehealthaides/assistants.Thelabormarketforthesethreeoccupationswasmorebalancedinurbanareas,withaslightindicationofshortage.
AsseeninFigure10,personalcareaideswerereportedtobeinlowdemandbyruralhomehealthagencies,whileabalancedlabormarketwasreportedbyurbanhomehealthagencies.Demandwasreportedtobenotablygreaterthansupplyforphysicaltherapistsforbothruralandurbanhomehealthagencies,withslightlystrongerdemandreportedbyurbanagencies.Slightlystrongerdemandwasreportedbyruralhomehealthagenciesforphysicaltherapyassistantsthanbyurbanhomehealthagencies.
Amongruralhomehealthagencies,demandforoccupationaltherapists,occupationaltherapyassistants,respiratorytherapists,andsocialworkerswasreportedtobegreaterthansupply,withasubstantialshortagereportedforoccupationaltherapyassistantsandsocialworkers(Figure11).Demandfortheseoccupationswasalsohighinurbanareas,withagreatershortfallofsupplyforoccupationalandrespiratorytherapistscomparedtooccupationaltherapyassistantsandsocialworkers.
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Figure8.Averagerankingoflabormarketdemandbygeography,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicategreatersurplusofnurses.)
Figure9.Averagerankingoflabormarketdemandbygeography,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicategreatersurplusofnurses.)
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4.0
4.5
5.0
Rural(n=5) Urban(n=20)
AverageRa
nking
StaffRNs
OtherRNs
NPs
4.0
3.5
4.0
3.53.73.4
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rural(n=5) Urban(n=20)
AverageRa
nking
Licensedpracticalnurses
Certifiednursingassistants
Homehealthaides/assistants
19
Figure10.Averagerankingoflabormarketdemandbygeography,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicategreatersurplusofnurses.)
Figure11.Averagerankingoflabormarketdemandbygeography,2015
Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicategreatersurplusofnurses.)
2.0
3.2
4.24.4
3.8 3.7
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rural(n=5) Urban(n=20)
AverageRa
nking
Personalcareaides
Physicaltherapists
Physicaltherapyassistants
4.24.4
4.8
3.84.0 4.0
4.6
3.6
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rural(n=5) Urban(n=20)
AverageRa
nking
Occupationaltherapists
Occupationaltherapyassistants
RespiratoryTherapists
SocialWorkers
20
CurrentEmploymentofStaffThelargestoccupationalgroupwithinArizona’shomehealthagencieswashomehealthaides/assistants(Table3).Thesecond-largestoccupationwasstaffRNs,with232reportedbyrespondingagencies.StaffRNsrepresentedmorethan80percentofallemployedRNs;anadditional56RNswerereportedtobeworkinginnon-staffrolessuchasmanagementandcarecoordination.Personalcareaide,LPN,andphysicaltherapyassistantemploymentlevelswerealsolargeathomehealthagencies,withatleast90ofeachoftheseoccupationsreported.
Homehealthagencieswereaskedtoindicatethenumbersoffull-timeandpart-timeemployeesforeachoccupation.AsseeninTable3,ofcurrentstaff,full-timeemploymentwascommonforRNsinnon-staffroles(92.9%),andabouthalfofhomehealthaides/assistants(50.7%)andphysicaltherapists(50.0%)wereemployedfull-time.Morethanhalfofworkersinotheroccupationswereemployedpart-time.HomehealthagenciesindicatedthatnoneoftheLPNsorNPstheyemployedworkedfull-time.
Table3.Numberofcurrentstaff(headcount)byposition,asofMay1,2015 Full-time Part-time*
Description Headcount %oftotal Headcount %of
total Total
StaffRNs 59 25.4 173 74.6 232 RNsinotherroles(management,carecoordination,utilizationreview,etc.) 52 92.9 4 7.1 56
NursePractitioners(NP) 0 0.0 2 100.0 2 Licensedpracticalnurses(LPN) 0 0.0 40 100.0 40 Certifiednursingassistants 62 45.3 75 54.7 137 Homehealthaides/assistants 150 50.7 146 49.3 296 Personalcareaides 40 31.0 89 69.0 129 PhysicalTherapists 25 50.0 25 50.0 50 PhysicalTherapyAssistants 34 37.8 56 62.2 90 OccupationalTherapists 9 32.1 19 67.9 28 OccupationalTherapyAssistants 23 39.0 36 61.0 59 RespiratoryTherapists 4 26.7 11 73.3 15 SocialWorkers(LCSW) 9 39.1 14 60.9 23
CurrentVacanciesFigure12andTable4presentvacancyratesbypositionasofMay1,2015.Thehighestvacancyrateswerereportedforoccupationaltherapyassistants(24.4%),respiratorytherapists(21.1%),andstaffRNs(20.5%).ThehighvacancyrateforRNsisconcerning,sinceRNscomprisealargeshareofallhomehealthstaff.Vacancyrateswereover10percentforRNsinnon-staffroles(13.8%),certifiednursingassistants(12.7%),personalcareaides(11.6%),physicaltherapyassistants(14.3%),occupationaltherapists(15.2%),andsocialworkers(17.9%).
21
Figure12.Vacancyratesbyposition,May1,2015
Table4.Vacancyratesbyposition,May1,2015 Full-time Part-time Total
Description Number Rate(%) Number Rate
(%) Number Rate(%)
StaffRNs 19 24.4 41 19.2 60 20.5RNsinotherroles(management,carecoordination,utilizationreview,etc.) 7 11.9 2 33.3 9 13.8NursePractitioners(NP) 0 0.0 0 0.0 0 0.0Licensedpracticalnurses(LPN) 0 0.0 0 0.0 0 0.0Certifiednursingassistants 9 12.7 11 12.8 20 12.7Homehealthaides/assistants 11 6.8 14 8.8 25 7.8Personalcareaides 10 20.0 7 7.3 17 11.6PhysicalTherapists 1 3.8 0 0.0 1 2.0PhysicalTherapyAssistants 7 17.1 8 12.5 15 14.3OccupationalTherapists 3 25.0 2 9.5 5 15.2OccupationalTherapyAssistants 4 14.8 15 29.4 19 24.4RespiratoryTherapists 2 33.3 2 15.4 4 21.1SocialWorkers(LCSW) 4 30.8 1 6.7 5 17.9
ChangesExperiencedinthePastYearHomehealthagencieswereaskedaboutchangesinstaffemploymentlevelsduringthepastyear.Figure13andTable5showthatgreatersharesofhomehealthagenciesreportedincreasedemploymentthandecreasedemploymentforalloccupationsexceptrespiratorytherapists,forwhomnochangeswerereported.Over54percentofhomehealthagenciesincreasedemploymentofstaffRNsinthepastyear.Over44percentofhomehealthagenciesreportedincreasedemploymentoflicensedpracticalnurses.Forallotheroccupations,themajorityofrespondingagenciesindicatedtherehadbeennochangeinemployment.
20.5%13.8%
0.0%0.0%
12.7%7.8%
11.6%2.0%
14.3%15.2%
24.4%21.1%
17.9%
0% 5% 10% 15% 20% 25% 30%
StaffRNsRNsinotherroles(management,care…
NursePractitioners(NP)Licensedpracticalnurses(LPN)
CertifiednursingassistantsHomehealthaides/assistants
PersonalcareaidesPhysicalTherapists
PhysicalTherapyAssistantsOccupationalTherapists
OccupationalTherapyAssistantsRespiratoryTherapistsSocialWorkers(LCSW)
22
Figure13.Changesinemploymentinthepastyear,byposition,2015
Table5.Changesinemploymentinthepastyear,byposition,2015 DifficultyRecruitingComparedtoLastYear
DecreasedEmployment IncreasedEmployment Nochange Responses
Position # % # % # % # StaffRNs 3 12.5 13 54.2 8 33.3 24 RNsinotherroles(management,carecoordination,utilizationreview,etc.)
1 4.8 5 23.8 15 71.4 21
NursePractitioners(NP) 1 25.0 0 0.0 3 75.0 4 Licensedpracticalnurses(LPN) 1 5.6 8 44.4 9 50.0 18
Certifiednursingassistants 0 0.0 8 34.8 15 65.2 23 Homehealthaides/assistants 0 0.0 5 31.3 11 68.8 16 Personalcareaides 0 0.0 1 16.7 5 83.3 6 PhysicalTherapists 3 14.3 7 33.3 11 52.4 21 PhysicalTherapyAssistants 0 0.0 4 30.8 9 69.2 13 OccupationalTherapists 3 15.0 6 30.0 11 55.0 20 OccupationalTherapyAssistants 1 10.0 3 30.0 6 60.0 10
RespiratoryTherapists 0 0.0 0 0.0 4 100.0 4 SocialWorkers(LCSW) 1 5.0 2 10.0 17 85.0 20
Homehealthagencieswereaskedaboutothertypesofenvironmentalchangesexperiencedoverthepastyear.Morethan54percentofhomehealthagenciesreportedanincreaseinclientvolume.Over33percentofhomehealthagenciesreportedfacingbudgetconstraints,andcurrentstaffconvertingfromparttimepositionstofull-timepositions.Twenty-ninepercentofhomehealthagenciesreportedcurrentstaffwereworkingmoreshifts.
0% 20% 40% 60% 80% 100%
StaffRNsRNsinotherroles(management,…
NursePractitioners(NP)Licensedpracticalnurses(LPN)
CertifiednursingassistantsHomehealthaides/assistants
PersonalcareaidesPhysicalTherapists
PhysicalTherapyAssistantsOccupationalTherapists
OccupationalTherapyAssistantsRespiratoryTherapistsSocialWorkers(LCSW)
Decreasedemployment
Nochange
Increasedemployment
23
Homehealthagencieswereaskedtoreportwhethertheyhadcreatednewjobclassificationsoverthepastyear.Figure14showsthatin2015,over62percentofhomehealthagenciesindicatedtheyhadnotcreatednewjobclassificationsinthepastyear.Oftheagenciesthatreportednewjobclassifications,themostfrequentlyreportednewjobclassificationswererelatedtocarecoordinationandclinicaldocumentationspecialists.
Homehealthagenciesreportedthatthechallengesassociatedwithhiringormovingstaffintothesenewrolesincludedrecruitingqualifiedstaffcapableofhandlinghighpatientacuityandhighpatientvolume.Theseareimportantfactorsinfluencingthecreationofnewjobclassifications,asthesepositionsmaynothaveexistedinthemarketpreviously,andthechallengesencounteredarenewtohomehealthagencies.
Figure14.Creationofnewjobclassificationsinthepastyear,2015
RequirementsforRNEmploymentAseriesofquestionsinthesurveyfocusedonRNemployment,becauseRNsarethelargestgroupofworkersinmosthomehealthagencies.AsseeninFigure15,85percentofhomehealthagenciesreportedhavingaminimumexperiencerequirementforRNhiring.Approximately88percentofthesehomehealthagenciesreportedhavingarequirementofatleast12monthsofexperiencetobehired;thenumberofmonthsofexperiencerequiredrangedfrom1to12months.Thirty-fivepercentofhomehealthagenciesrequiredaminimumamountofexperienceinaprimary/ambulatorycaresetting.
Approximately60percentofhomehealthagenciesreportedapreferenceforhiringbaccalaureatetrainedRNs.Twenty-fivepercentofhomehealthagenciesreportedrequiringabaccalaureatedegree.Homehealthagencieswereaskedaboutsecondlanguageskillsasarequirementforemploymentin2015;15percentreportedrequiringasecondlanguage,and25percentindicatedthatitwasapreference.Ofthesehomehealthagencies,Spanishwasmostoftenreportedasthepreferredlanguage.
Homehealthagenciesweregiventheopportunitytoreportothertypesofrequirementsforemployment.Mostofthewrite-inresponsesreportedrequirementssuchasRNlicensureinArizona,a
37.5%
62.5%
Newjobclassifications
Nonewjobclassifications
24
validdriver’slicense,avehicle,andautomobileinsurance.Twentypercentofhomehealthagenciesindicatedhavingnospecificrequirementsforemployment.
Figure15.Requirementsforregisterednursingemployment,2015
RespondentswereaskedtoreporttheshareofRNsthatattainedaBSNandarecurrentlyemployedintheiragency.Theresponsechoiceswerepresentedascategories,listedinTable13.Forty-fivepercentofallhomehealthagenciesreportedthatBSN-preparedRNsrepresent0-25percentoftheiremployedRNs.ThirtypercentofrespondentsindicatedthatRNsholdingaBSNdegreeaccountedforover50percentoftheiremployedRNs.
Figure16.CurrentlyemployedBSN-preparedregisterednurses,2015
Homehealthagencieswereaskedtoindicatewhetherornottheyhadgoalsorplansinplacetoincreasethenumberofbaccalaureate-preparednursesonstaff.Only2of23respondingagencies(8.7%)havesuchplans.Amongthosewithsuchplans,theirtargetistohaveatleast75percentoftheirRNsholdabaccalaureatedegreewithinthenextthreeyears.Twoagencies(9.1%)indicatedthatnewlyhiredRNs
85.0%
35.0%
60.0%
25.0%
25.0%
15.0%
35.0%
20.0%
0% 20% 40% 60% 80% 100%
Minimumexperiencerequirement
Minimumexperienceinprimarycare/ambulatorycarerequirement
Baccalaureatedegreepreferred
Baccalaureatedegreerequired
Secondlanguagepreferred
Secondlanguagerequired
Otherrequirementsforemployment
Nospecificrequirements
45.0%
25.0%
20.0%
10.0% 0– 25%haveBSN
26– 50%haveBSN
51– 75%haveBSN
Morethan75%haveBSN
25
whodonothaveabaccalaureatedegreeareexpectedtoobtainonewithinaspecifiedamountoftime.Three(13.6%)reportedthatnothavingaBSNhasnoeffectonbeingpromotedbeyondthepositionofstaffnurse.
ThereisaperceptionamongsomeRNsthattheBSNdegreehaslittlepotentialtoincreaseearnings.Table6suggeststhisperceptionmightbepresentinsomehomehealthagenciesinArizona,as59percentofhomehealthagenciesreportedthattheirorganizationdoesnotdifferentiatesalarybydegree.InadditiontodifferentiatingRNsalariesbasedonthetypeofdegreeheld,homehealthagencieswereaskedaboutdifferentiationbasedonadvancedcertifications(e.g.criticalcare,peri-operative,oncology,etc.).Thesameshareofhomehealthagenciesreportednosalarydifferentiationbasedondegreeorcertification.
Table6.OrganizationdifferentiatesRNsalariesbydegreeoradvancedcertification,2015
Differentiatebydegree Differentiatebycertification
Description # % # %Organizationdifferentiatessalary 9 41.0 9 41.0Organizationdoesnotdifferentiatesalary 13 59.0 13 59.0Total 22 100.0 22 100.0
Homehealthagencieswereaskedaboutthetypesofsupportofferedtoemployedstaffwhoareenrolledinadegreeprogramorworkingtowardacertification(Figure17).Over39percentofhomehealthagenciesreportedofferingtuitionreimbursementinsupportofemployedstaffseekinganadditionaldegree.Norespondentreportedtheprovisionofpaidtimeoffforcoursework.Over17percentoftherespondinghomehealthagenciesreportedallowingcurrentstafftotakeunpaidtimeforcoursework.HomehealthagenciesweregiventhechancetodescribeothertypesofsupportforRNsworkingtowardadegreeorcertification.Responsesincludedloanforgivenessprogramsandemploymentaftergraduationfromtheprogram.
Figure17.Supportforstaffworkingtowarddegreesorcertification,2015
HomehealthagenciesthatprovidetuitionreimbursementwereaskedaboutthemaximumbenefitpaidperRNperyear.Table7showsthatamajorityofhomehealthagenciesofferbetween$1,500and$2,999intuitionreimbursement.ThisisnotablylowerthanthetuitionofferedbyhospitalsinArizona.Table7.TuitionreimbursementbenefitsperRNperyear,2015
39.1%
0.0%
17.4%
39.1%
13.0%
0% 20% 40% 60% 80% 100%
Tuitionreimbursement
Paidtimeoffforcoursework
Approveduseofunpaidtimeoffforcoursework
None
Other
26
Maximumperyear
Description # % $0-$1,499 1 14.3 $1,500-$2,999 4 57.1 $3,000-$4,499 1 14.3 $4,500-$5,999 1 14.3 Total 7 100
ProfessionalCompetencyGapsHomehealthagencieswereaskedtodescribethemostimportantcompetencygapstheyencountered.GapsweremostoftennotedregardingRNs,physicaltherapists,nursingassistants,andmanagement/administrativestaff.Thereportedcompetencygapsfortheseoccupationsinclude:knowinghowthehomehealthagencynurseroleprovideshomehealth/hospicecare,beingabletoefficientlyhandletheirpatientvolume,andprovidingcompletedocumentationofpatientvisits.
ClinicalResidencyProgramsforNewRNGraduatesHomehealthagencieswereaskedwhetherornottheysponsorclinicalresidencyprogramsfornewgraduateswhoarenotguaranteedtobehired(Table8).Only2of23respondingagenciesindicatedtheyhavesuchaprogram.Thosewithprogramsreportedthatthelengthofeducationislessthan8weeks,andthattheyeducatefewerthan5newgraduatespercohort.Programswereofferedatfrequenciesrangingfromfourtimesayear,toevery4to6weeks.Alloftheseprogramsweredevelopedinpartnershipwithaschoolofnursing,andstudentswerepaidduringparticipation.Oneprogramindicatedthattheyhiredatleast75percentoftheirresidencygraduateslastyear,andtheotherprogramhiredfewerthan25percent.
Althoughcomparativelyfewhomehealthagencieshaveformalresidencyprogramsinwhichnewgraduatesarenotguaranteedtobehired,over78percentofallhomehealthagencieshavesomekindoforientationprogramfornewlyhiredRNs.Table8showsthatamajorityoftheseonboardingprogramsarefewerthan10weeksinlength,andnoonboardingprogramwaslongerthan19weeks.
Table8.Orientation/onboardingprogramforrecenthires,2015Description # %
Haveanonboardingprogram 18 78.3Don'thaveanonboardingprogram 5 21.7
Lengthofprogram(inweeks) # %Lessthan10weeks 14 93.310-19weeks 1 6.7
EmploymentExpectationsfortheNextYearHomehealthagencieswereaskedtoreporttheirexpectationsforemploymentoverthenextthreeyears.Figure18andTable9showthatamajorityofhomehealthagenciesexpectincreasedemploymentforallpositionsinthisperiod.Themostfrequentlyreportedreasonsforexpected
27
employmentchangesinclude:increasedclientvolume,increasedagencycapacity,andincreasesintherangeofservicesoffered.Toalesserextent,respondentsnotedthatincreasedclientacuityandincreasedworkloadforcurrentstaffalsoinfluencedtheirexpectationsforthenextthreeyears.
Figure18.Expectationsforemploymentinthenextthreeyears,2015
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
StaffRNs
RNsinotherroles(management,carecoordination,utilizationreview,etc.)
NursePractitioners(NP)
Licensedpracticalnurses(LPN)
Certifiednursingassistants
Homehealthaides/assistants
Personalcareaides
PhysicalTherapists
PhysicalTherapyAssistants
OccupationalTherapists
OccupationalTherapyAssistants
RespiratoryTherapists
Decreasedemployment Nochange Increasedemployment
28
Table9.ExpectationsforRNemploymentinthenextthreeyears,2015 Expectationsforemploymentinthenext3years
Decrease IncreasedEmployment Nochange Responses
Position # % # % # % # StaffRNs 1 4.3 18 78.3 4 17.4 23 RNsinotherroles(management,carecoordination,utilizationreview,etc.)
1 5.0 13 65.0 6 30.0 20
NursePractitioners(NP) 1 33.3 2 66.7 0 0.0 3 Licensedpracticalnurses(LPN) 1 5.9 15 88.2 1 5.9 17 Certifiednursingassistants 1 4.8 15 71.4 5 23.8 21 Homehealthaides/assistants 1 6.7 11 73.3 3 20.0 15 Personalcareaides 1 16.7 4 66.7 1 16.7 6 PhysicalTherapists 1 5.0 15 75.0 4 20.0 20 PhysicalTherapyAssistants 1 7.1 8 57.1 5 35.7 14 OccupationalTherapists 1 5.3 13 68.4 5 26.3 19 OccupationalTherapyAssistants 1 9.1 6 54.5 4 36.4 11 RespiratoryTherapists 1 20.0 3 60.0 1 20.0 5 SocialWorkers(LCSW) 1 5.0 7 35.0 12 60.0 20
Table10showsthatover30percentofhomehealthagenciesanticipatethecreationofnewRN-relatedjobclassificationsinthenexttwoyears.Notethat37.5percentofhomehealthagenciesreportedthattheycreatednewRNjobclassificationsoverthepastyear.Thissuggeststhathomehealthagenciesbelievethatcaredemandsrequiresimilarratesofcontinuednewjobclassificationcreationinthecomingyears.Theagenciesthatanticipatecreatingnewjobclassificationsinthecomingyearexpectthemtoberelatedtocarecoordinationandcasemanagement.Homehealthagenciesplantodevelopthesenewrolesthroughtrainingandmentoring,carefulrecruitment/networkingwithspecificjobdescription,andincentiveslikesigningbonuses,andhigherwages.
Table10.Plannednewjobclassificationsinthenexttwoyears,2015Description # %Plannednewjobclassifications 7 30.4Noplannednewjobclassifications 16 69.6
Total 23 100.0
Homehealthagencieswereaskedtodescribehowconcernedtheyfeltaboutaseriesofstatementsontheadequacyoftheiragency’sworkforce(Figure19&Table11).Theirgreatestconcernsregardingtheadequacyoftheirworkforcewereabouttheimpactoffallingreimbursementlevels,potentialstatebudgetcutstoMedicaid,andthebehavioralneedsoftheirpatients.Theimpactoftheexpansioninhealthinsurancecoveragewasofconcerntomanyhomehealthagencies.Homehealthagenciesindicatedthattheyaresomewhatconcernedaboutdisabilityaccommodationsand/orphysicallimitationsofstaff,staffleavesofabsence,andchangingemploymentgoalsofnewworkers(Millennials).
29
Figure19.Impactonadequacyonhospital’sworkforce,2015
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
AginghealthcareworkforcewithinfacilityPopulationgrowthinregionPopulationaginginregion
CulturaldiversityLinguisticcapabilities
Impactoftheexpansioninhealthinsurance…ImpactofpotentialstatebudgetcutstoMedicaid
StaffleavesofabsenceDisabilityaccommodationsand/orphysical…
BehavioralhealthneedsofpatientsReimbursementlevelsdropping
Increasingdesireofworkerstobeonapart-…Changingemploymentgoalsofnewworkers…
Notatallconcerned Slightlyconcerned Somewhatconcerned
Moderatelyconcerned Extremelyconcerned
30
Table11.Impactonadequacyonhospital’sworkforce,2015Impactonadequacyoflong-termcarefacility’workforce
Notatallconcerned Slightly
concerned Somewhatconcerned Moderately
concerned Extremelyconcerned
Responses
Description # % # % # % # % # % #
Aginghealthcareworkforcewithinfacility 11 47.8 8 34.8 1 4.3 2 8.7 1 4.3 23
Populationgrowthinregion 12 52.2 10 43.5 4 17.4 2 8.7 1 4.3 23Populationaginginregion 11 47.8 7 30.4 6 26.1 2 8.7 2 8.7 23Culturaldiversity 15 68.2 7 31.8 4 17.4 2 8.7 0 0.0 22Linguisticcapabilities 11 47.8 9 39.1 7 30.4 2 8.7 0 0.0 23Impactoftheexpansioninhealthinsurancecoverage 5 21.7 10 43.5 3 13.0 6 26.1 5 21.7 23
ImpactofpotentialstatebudgetcutstoMedicaid 4 17.4 0 0.0 2 8.7 11 47.8 12 52.2 23
Staffleavesofabsence 8 34.8 6 26.1 9 39.1 3 13.0 3 13.0 23Disabilityaccommodationsand/orphysicallimitationsofstaff 9 39.1 7 30.4 10 43.5 2 8.7 1 4.3 23
Behavioralhealthneedsofpatients 6 26.1 6 26.1 3 13.0 7 30.4 7 30.4 23Reimbursementlevelsdropping 3 13.0 2 8.7 2 8.7 7 30.4 15 65.2 23Increasingdesireofworkerstobeonapart-timeschedule 7 30.4 10 43.5 6 26.1 4 17.4 2 8.7 23
Changingemploymentgoalsofnewworkers(e.g.,Millennials) 4 17.4 9 39.1 10 43.5 1 4.3 5 21.7 23
31
CONCLUSIONS
LabormarketconditionsfacedbyArizonahomehealthagenciesindicateshortagesinmanyoccupations,includingstaffRNs,physicaltherapists,occupationaltherapists,physicalandoccupationaltherapyassistants,respiratorytherapists,andsocialworkers.Reportedshortagesvariedacrossthestate,withsomeoccupationshavingthegreatestshortageinPhoenix,othersinTucson,andstillothersintherestofArizona.Agenciesinruralareasreporteddeepershortagesformostoccupationsthandidagenciesinurbanareas.
Homehealthagenciesexpectemploymentincreasesforeveryoccupationoverthenextthreeyears.Someagenciesareinvestingintheirworkforcethroughtuitionreimbursement,andasmallnumberoffernurseresidencyprogramsincollaborationwithnursingeducationprograms.Nearlyone-thirdexpecttodevelopnewjobclassificationsinthenexttwoyears,withnewclassificationsprimarilyrelatedtocarecoordinationandmanagement.
Agenciesexpressedconcernabouttheimpactofreimbursementlevelsdropping,potentialstatebudgetcutstoMedicaid,andthebehavioralneedsoftheirpatientsontheadequacyoftheirworkforce.Homehealthagencyleaderswillneedtoworkcloselywithlocalandstateeducationalinstitutions,policymakers,andbusinessleaderstoaddresstheseconcerns.Furthermore,theyshoulddevelopstrategiestoimprovetheiremployees’knowledgeofhowtomanagebehavioralhealthissues.
32
ACKNOWLEDGEMENTS
ThecollaborationoftheAdvisoryCommitteeconvenedbyVitalystFoundation,theCityofPhoenix,andtheGreaterPhoenixChamberofCommercewasimportanttothedevelopmentofthesurveyquestionnaireandconductingofthesurvey.WespecificallythankClaudiaWhiteheadforherwork.
ThisstudybenefittedfromtheworkofMatthewWilliamsandKatieHarrarwhoassistedwithreviewingthedatabase,makingtelephonecallstoincreaseresponserates,reviewingdata,andfindingcontactinformation.GinachukwuAmah,NicholasOlson,andIgorGeynprovidedvaluableassistanceinproofreadingthisreport.
33
AppendixTable1.Labormarketdemandbygeographicregion,2015 Region
Description: Phoenix Tucson Rest of
AZ Staff RNs % % %
Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 0.0 0.0 Demand is in balance with supply 27.3 16.7 0.0 Moderate demand: some difficulty filling open positions 45.5 50.0 71.4
High demand: difficult to fill open positions 27.3 33.3 28.6 Total 11 6 7 RNs in other roles Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 0.0 20.0 Demand is in balance with supply 44.4 16.7 0.0 Moderate demand: some difficulty filling open positions 44.4 83.3 60.0
High demand: difficult to fill open positions 11.1 0.0 20.0 Total 9 6 5 Nurse Practitioners Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 0.0 0.0 Demand is in balance with supply 0.0 0.0 100.0 Moderate demand: some difficulty filling open positions 100.0 0.0 0.0
High demand: difficult to fill open positions 0.0 0.0 0.0 Total 1 0 1 Licensed practical nurses (LPN) Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 0.0 0.0 Demand is in balance with supply 55.6 20.0 50.0 Moderate demand: some difficulty filling open positions 44.4 80.0 25.0
High demand: difficult to fill open positions 0.0 0.0 25.0 Total 9 5 4 Certified nursing assistants Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 11.1 0.0 0.0 Demand is in balance with supply 22.2 40.0 50.0 Moderate demand: some difficulty filling open positions 55.6 60.0 33.3
High demand: difficult to fill open positions 11.1 0.0 16.7
Total 9 5 6
34
Region
Description: Phoenix Tucson Rest of
AZ Home health aides/assistants % % %
Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 16.7 0.0 0.0 Demand is in balance with supply 16.7 80.0 33.3 Moderate demand: some difficulty filling open positions 66.7 20.0 66.7
High demand: difficult to fill open positions 0.0 0.0 0.0 Total 6 5 3 Personal care aides Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 33.3 0.0 100.0 Demand is in balance with supply 0.0 100.0 0.0 Moderate demand: some difficulty filling open positions 66.7 0.0 0.0
High demand: difficult to fill open positions 0.0 0.0 0.0 Total 3 2 1 Physical Therapists Demand is much less than supply available 0.0 0.0 14.3 Demand is less than supply available 0.0 0.0 0.0 Demand is in balance with supply 11.1 40.0 0.0 Moderate demand: some difficulty filling open positions 33.3 0.0 14.3
High demand: difficult to fill open positions 55.6 60.0 71.4 Total 9 5 7 Physical therapy assistants Demand is much less than supply available 0.0 0.0 16.7 Demand is less than supply available 20.0 33.3 0.0 Demand is in balance with supply 20.0 0.0 0.0 Moderate demand: some difficulty filling open positions 60.0 33.3 33.3
High demand: difficult to fill open positions 0.0 33.3 50.0
Total 5 3 6
Occupational therapists % % %
Demand is much less than supply available 0.0 0.0 14.3 Demand is less than supply available 0.0 25.0 0.0 Demand is in balance with supply 12.5 0.0 0.0 Moderate demand: some difficulty filling open positions 37.5 0.0 14.3
High demand: difficult to fill open positions 50.0 75.0 71.4 Total 8 4 7
35
Region
Description: Phoenix Tucson Rest of
AZ Occupational therapy assistants % % %
Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 33.3 0.0 0.0 Demand is in balance with supply 0.0 0.0 0.0 Moderate demand: some difficulty filling open positions 66.7 50.0 25.0
High demand: difficult to fill open positions 0.0 50.0 75.0 Total 3 2 4 Respiratory Therapists Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 0.0 0.0 Demand is in balance with supply 0.0 0.0 50.0 Moderate demand: some difficulty filling open positions 100.0 0.0 0.0
High demand: difficult to fill open positions 0.0 0.0 50.0 Total 1 0 2 Social Workers (LCSW) Demand is much less than supply available 0.0 0.0 0.0 Demand is less than supply available 0.0 25.0 0.0 Demand is in balance with supply 62.5 25.0 14.3 Moderate demand: some difficulty filling open positions 25.0 25.0 28.6
High demand: difficult to fill open positions 12.5 25.0 57.1 Total 8 4 7