The COVID-19 pandemic has left state and local health officials facing extreme workforce shortages. The millions of federal relief money that followed provided an exceptional opportunity to solve this problem.

How they do it, a group of health, education and state leaders have 107 proposals to do so.

Two years in development Delivering Care: A Strategic Plan to Expand and Support New Hampshire Health Workers has both immediate and long-term recommendations, from retaining staff with wellness programs and professional mentoring to persuading Medicaid, Medicare, and private insurance companies to expand coverage for case management and community health workers. Some of the recommendations call for policy changes or new funding, while others do not require money, but collaboration between stakeholders and the creation of a central repository of dispersed workforce data across the state.

“In this state, we often address issues in a very piecemeal fashion,” said Kim Firth, program director at the Health Foundation, which funded and led the project in partnership with the Public Health Institute. “We want it to be action-oriented. We don’t want this plan to sit on the shelf. We really need to work together to make this happen.”

Healthcare is one of the largest sectors in the state, employing approximately 62,250 people. Labor force projections show almost all specialties are growing; By 2030, the number of nurse practitioners alone will increase by nearly 60 percent, according to the State Department of Employment Security.

The two organizations are quietly implementing the plan, with a broad audience in mind that includes not only hospital personnel managers and heads of government agencies, but also nonprofits, health advocates and lawmakers. And they say parts of the plan, such as prioritizing employee career development and using technology to reduce workload, could be carried over to any industry.

The new strategic plan for expanding the health workforce requires immediate and long-term initiatives. (Screenshot)

Firth and Margaret Frankhauser of the New Hampshire Institute of Public Health were encouraged by the feedback on the plan.

Frankhauser said that at a recent meeting, Health and Human Services Commissioner Laurie Chibinette called on almost 65 participants to read the plan and choose between three and five priorities that they thought the department could fund, lead or play a role in implementing.

“She told the group very clearly, ‘We have limited funding and we’re interested in your ideas on where we can put some of that money,'” Frankhauser said.

The plan’s 107 strategies are organized into four themes: recruitment and retention of health workers; rethinking policies that impede labor force development; collection and use of data for decision-making; and creating a public or private group to promote the plan to ensure it is not delayed.

It is the first one that gets the most attention.

Like the rest of the plan, strategies for expanding the workforce pipeline range from those that are relatively easy to implement to others that require investment within one to two years.

Instead of doing exit interviews, the plan recommends periodically holding retention interviews to find out what works and what needs improvement. He suggests creative recruiting by promoting healthcare to older workers as a “second job” and encouraging parents to promote the field to their school-age children.

Recommendations such as providing more tuition assistance and reasonable, competitive wages are more difficult to implement.

Heather Carroll, director of advocacy for the NH Alliance for Healthy Aging and among the 70 people who worked on the plan, noted that licensed nursing assistants can earn more in Maine, Massachusetts and Vermont than the average hourly wage of $11.25 in New Hampshire. She also said New Hampshire LNAs are “golden” to neighboring employers because their training allows them to take their medication.

“During the pandemic, (other states) were willing to pay stipends for living expenses and travel expenses if they came to Massachusetts,” Carroll said. “When you’re trying to meet needs and you’re the sole breadwinner in your home, these options become very attractive.”

Also attractive, Carroll says, is a job that provides a reliable schedule, rather than requiring workers to stay after a shift to make up for staffing shortages that are common in industries.

Low wages have reduced the direct care workforce, allowing aging seniors and people with disabilities to receive home care and not visit nursing homes. The federal Choices for Independence program, which reimburses providers for these services, is the primary provider of this home care.

“CFI is a lot cheaper than putting someone in a nursing home that depends on government dollars,” Carroll said. “So why isn’t the government investing in this?”

Other ideas include creating a centralized list of internships, mentoring, and on-site training opportunities for students, and making it easier and faster to obtain a license in New Hampshire for in-state and out-of-state providers. Lindsey Courtney, head of the state’s licensing office and who helped develop the plan, has already made it a priority.

The plan recognizes, but does not attempt to address, perhaps the biggest problems for the growth of any workforce in this state: the lack of affordable housing and childcare. He recommends that employers alleviate these barriers by providing financial assistance to both.

Will Stewart, chief executive of Stay Work Play, is facing huge challenges in the nonprofit’s efforts to bring new people into the state.

“Many healthcare workers, especially entry-level workers, are underpaid. This is not uncommon for entry-level workers in a number of industries,” he said. “Combined with the high cost of housing, combined with high student debt payments… and the fact that you will probably have to pay for a car because public transportation is not what I would call reliable, New Hampshire is an expensive place. for life”.

One woman’s comments stuck with him from a recent visit to the Upper Valley. “She said it was a great place to start a family, but a terrible place to start one,” he said. “People want to live here, they want to stay or move here, but they just can’t afford it.”

Stewart is encouraged by what he sees as increased momentum in an attempt to solve both problems.

In previous positions, Frankhauser, who ran health care organizations before joining the Public Health Institute, recruited medical staff from competitors. Her mind has changed on this, and she believes that the fact that so many competing healthcare employers have contributed to the plan is indicative of a common understanding that an expansion of the workforce is necessary not just for their office, but for the state.

“I think this process makes us all recognize that the tide is lifting us all and lifting us all,” she said.

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