Clarion Forest Visiting Nurses Association serves Clarion, Forest, and Jefferson counties in Pennslyvania, which are predominately rural areas.
After six years as a neonatal intensive care unit (NICU) nurse, Lisa Steiner decided to switch to home health. With a 10-month-old at home, the flexibility in scheduling drew her to the sector.
"From when I started 30 years ago to what I'm seeing now, it’s just amazing the skills that we're doing in the home that we did not do when I first came," Steiner, CEO and chief nursing officer for Clarion Forest Visiting Nurses Association, told HealthLeaders.
Clarion Forest serves Clarion, Forest, and Jefferson counties in Pennsylvania, which are predominantly rural areas. Due to their location, Steiner's employees travel an average of 40-80 miles per day to care for patients.
All sectors of healthcare are struggling to fill empty roles amid a workforce shortage exacerbated by the COVID-19 pandemic. Besides having to compete with higher wages offered elsewhere, rural providers and agencies like Clarion Health are tasked with trying to convince talent, namely young people, to want to live in the area as well.
"Our slogan is 'neighbors taking care of neighbors,' and that's truly what it is," Steiner said. Most of her nurses live in the area because they want to raise their families in a rural area.
Last year, Steiner and other local healthcare leaders from nursing homes and hospitals formed the Clarion Regional Health Care Collaborative. Meeting monthly, they work together to figure out ways to get people involved in healthcare and keep them local.
A number of health care systems have formed educational partnerships with their local colleges and vocational schools to develop a talent pipeline. Similarly, Clarion Forest partners with the local university, allowing medical students to do their clinical rotations with her agency, shadowing one of her nurses for an eight-hour day.
Remote patient monitoring technology has become almost commonplace for home health agencies, but much of the area Clarion Forest services doesn’t have internet access or cellular tower service. While they're currently working with the county on getting those services, Steiner said it could be years from now before they see anything come to fruition.
She was able to get a grant that covers most of the cost of Clarion Forest's remote patient monitoring needs.
"Even though I have that, I still have to pay a monthly fee to actually have the data transmitted," Steiner added. "So, what we do is have those clients that don't have Wi-Fi or cell towers call in their readings to our office."
When it comes to selling the idea of living in the area, she boasts of the agency's family oriented culture and the community's support for her employees. When their clinical manager unexpectedly died last spring, the employees came together and offered extra assistance wherever they could. In September, when Clarion Forest held a golf outing in their teammate’s memory, much of the community came out and showed their support as well.
"My staff, we all know each other, we all care about each other. There's no better place to work," Steiner said. "When I say, 'neighbors taking care of neighbors,' the whole community just rallied together."
Making it work
She acknowledges that the agency's familial culture only goes so far when recruiting potential employees. According to an internal census from 2021 to 2022, they admitted 300 more patients than they did the previous year. However, due to low reimbursement rates and the role it plays in their financial well-being overall, it's often difficult to ensure that her employees receive a cost-of-living increase in their wages each year.
"This year when we looked at our budget, I cut as much as I could and just went to my board and said, 'How do I not give my staff a 3% raise this year with inflation?" Steiner explained. "How do I not do that? Then you've got to find those funds. I've tightened the straps as much as I can, so you try to figure out ways, look at everything you can look at."
It's an exhausting and frustrating situation, she said, because they're busier than they've ever been. Ideally, she wants to be able to offer a cost-of-living increase each year, but the low reimbursement rates don't always allow for it.
There have been calls from leaders in different sectors of healthcare for policy and lawmakers to do more to help them, especially regarding Medicaid reimbursements.
"The reimbursement [model] needs to be looked at. I have a couple of payers that are very fair, I have another that's not; they're well below substandard on reimbursement," Steiner said.
Across the board, she said, insurances need to be looked at, along with Medicare managed care products.
"Health insurance rates go up, so we're paying for health insurance for our employees and every year everything goes up," she added. "So if your reimbursement doesn't go up, how do you continue to stay afloat?"
“Our slogan is 'neighbors taking care of neighbors,' and that's truly what it is.”
Lisa Steiner, CEO and chief nursing officer, Clarion Forest Visiting Nurses Associations
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
Rural providers struggle to compete with hospitals and larger organizations that can offer higher wages, as well as finding talent that want to stay in the area.
Most of the areas that Clarion Forest serves don't have internet or cellular service, which makes using remote patient monitoring technology difficult.
With inflation and low reimbursement rates, it's difficult to ensure that employees recieve a cost of living increase each year.