home health agencies-report...emerging occupations that interact with home health care, such as...

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




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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HomehealthagenciesinArizona

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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

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fillingpositions

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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).



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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.)



4.4

4.14.3

3.6

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SocialWorkers

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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)



Personalcareaides

PhysicalTherapists

PhysicalTherapyAssistants

OccupationalTherapists

OccupationalTherapyAssistants


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


AZ Home health aides/assistants % % %


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 % % %


High demand: difficult to fill open positions 50.0 75.0 71.4 Total 8 4 7

35

Region


AZ Occupational therapy assistants % % %


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

home health agencies-report...emerging occupations that interact with home health care, such as...

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