Budget provision aims to ease staff constraints in county nursing homes
The Senate Finance Committee voted in favor of a budget amendment last Monday that would provide licensed nursing assistants reimbursement for their certification program to become a medication nursing assistant.
According to Sen. Howard Pearl, a Loudon Republican who introduced the amendment, MNA certification would play an important role in easing the workload of nurses at nursing homes and hospitals.
“When it comes to dispersing certain medications, the LNAs themselves are not able to do it without the medical certification, or becoming an MNA,” he said.
The proposed $200,000 in funding comes as New Hampshire continues to experience a statewide shortage of health care workers. According to a 2022 plan by the Endowment for Health to address this issue, the Granite State is projected to be 10th among U.S. states most impacted by severe nursing shortages.
The health care community has said that its inability to offer nurses higher wages has prompted many to take higher paying jobs in neighboring states. An aging state population also creates its own pressures.
“In New Hampshire, we have an aging workforce – the silver tsunami is coming,” said Kate Horgan, vice president of the Dupont Group representing the New Hampshire Association of Counties. “And unless we get people to move to New Hampshire, there aren’t people to take those entry level positions as people move up the promotion chain.”
Nursing homes are especially taking a hit, as the industry struggles to recruit and train caregivers.
“We are experiencing workforce shortages across the board, which has led to counties having to close beds at 11 nursing home facilities just because we don’t have staff,” said Horgan.
Brendan Williams, president and CEO of the New Hampshire Health Care Association, relayed the same concerns. “That in turn, then is bottlenecking the hospitals, because the hospitals get jammed up with those that could be discharged into a nursing home,” he said.
Under federal law, LNAs who choose to work in county nursing homes are reimbursed for their tuition. The new amendment would create a similar state-level reimbursement for MNA certification.
“LNAs are some of our lowest paid staff and can’t necessarily afford this course unless their institution pays for it,” said Horgan. “If they do that, then they are able to take some pressure off of those registered nurses.”
The amendment appropriates $200,000 in the next two-year budget for the purpose of reimbursing MNA certification, which is expected to provide for about 200 LNAs. There is also hope that the funding may encourage more health care professionals to work in the state.
“If there’s a pathway forward that someone can see to advance their career, that makes it more likely for them to stay within our institution,” said Horgan.
Williams described the budget provision as helpful, but suggested more change was needed. He sees increasing Medicaid reimbursement as a greater priority, “so that facilities could spend more money, hiring holidays and recruitment or retention.” After hearing from health care providers about staff shortages, the House approved $134 million for Medicaid rates in April. The Senate Finance Committee has proposed reducing that to $119 million.
Nationally, more nurses and health care workers are taking jobs with staffing agencies that charge high rates and strain nursing home and hospital budgets, or even leaving the sector altogether for lower-stress jobs.
On the state level, Williams pointed to a lack of affordable housing, inflation, and competitive Medicaid rates in Massachusetts as barriers for nurses seeking work in New Hampshire.
“Even before the pandemic, we had an emigration of thousands of New Hampshire nurses, social workers, and others who go and work each day in Massachusetts,” he said. “And I’m sure that that has just gotten even worse, since the pandemic began.”
The Senate Finance Committee will hold a final vote on its proposal of $119 million for Medicaid funding in the coming weeks. Williams hopes that ultimately the state budget will support greater investment.
“We’re at a tipping point here with the care economy, and the question is, you know, whether they’ll make the right investment and save it long term, or whether they’ll just let it continue to slide,” he said.