State hospitals, Kansas Neurological Institute brave staffing challenges amid COVID pandemic
Lois Pearce wore a variety of hats during her 33 years working at Osawatomie State Hospital.
Her past 17 years were spent as a mental health technician and mental health aide, two of the most in-demand roles at Osawatomie and Larned State Hospital, the state's two mental health hospitals, which provide care for adults with psychiatric conditions.
But in her three-decades-plus of work, Pearce said some things remained largely consistent: structural factors that made it hard to bring staff aboard, with a trying work environment, low pay and mismanagement.
"Like Abraham Lincoln said, I've been driven to my knees by the overwhelming conviction that I just had nowhere else to go," she said. "That's my memory of working there."
Hiring and retaining workers has been a long-standing issue for the state's mental health hospitals, as well as the Kansas Neurological Institute and Parsons State Hospital, problems magnified during the COVID-19 pandemic.
Meanwhile, efforts to expand capacity at Osawatomie State Hospital were slowed during the pandemic as well, delaying progress toward lifting a long-standing pause on admissions, which advocates say has severely strained the state's mental health infrastructure.
All the while, remaining staff have been forced to do more with less, with workers often pulled from their normal roles to fill in at other positions. Employees have worked overtime due to the large number of vacancies and using days off has been a longstanding challenge.
"It was bad before, and I can only imagine how much worse the pandemic made it," Pearce said.
Staffing challenges exist pre-pandemic, worsen due to COVID-19
Kansas' state hospitals play a specific role in the state's mental health system, taking in patients with serious or acute mental health conditions upon referral from community providers or providing care for those under court order.
KNI and Parsons State Hospital, meanwhile, care for those with serious intellectual and developmental disabilities, with those two facilities caring for a combined 301 individuals.
While larger struggles with retaining and attracting workers existed throughout Pearce's career at Osawatomie, Pearce said things were particularly strained under Gov. Sam Brownback, with funding cut and management struggling to run the show.
Things got to the point where the federal government halted Medicare payments to Osawatomie State Hospital in December 2015 over safety concerns due to staffing shortages and working conditions, costing the state millions of dollars. The facility regained its certification in 2017.
One of the biggest frustrations brought on by the staff shortage, Pearce said, was an inability to use time off. That was of particular concern for her, as she frequently cares for an adult child with developmental disabilities. Things got to the point where she launched a months-long crusade to use leave under the federal Family and Medical Leave Act.
In 2016, Kyle Nuckolls, a mental health technician at Larned State Hospital, told legislators the facility suffered from a culture of "fear" and a lack of transparency, though he praised the work of the hospital's new leadership to change that.
"Many of our employees are afraid," Nuckolls said. "They are afraid of losing their jobs over small mistakes, mistakes that are often made because the employee has worked 20 or 30 hours of overtime in five days."
Kansas aims to hike pay as means of attracting staff
Staff say some of the historical problems have eased — but new issues have also cropped up. Overall staff vacancy rates at Larned and Osawatomie are hovering around 38%, but certain positions have even higher rates.
About two-thirds of all licensed mental health technician spots at Larned as of September are vacant, according to Scott Brunner, deputy secretary of hospitals and facilities at KDADS. For registered nurses, the number is 57%.
So many nursing positions are vacant that the number of nurses required to work extra shifts is decreasing simply because there are fewer people to mandate.
Other workers are often pulled out of their usual roles and moved elsewhere where there is a greater need, such as during meal times, said Sarah LaFrenz, president of the Kansas Organization of State Employees, the union representing state hospital workers. But, she noted, this upsets the predictability patients rely on.
"For mental health patients, they get used to the people that are there, that helps with the stability for their behavior," she said. "And when you're switching people in and out, that disrupts the patients, which makes people have more behavioral problems, which then exacerbates any of the problems you're dealing with as a worker on those floors.
"And then you have fewer people to deal with it."
This isn't a problem unique to the state hospitals — the COVID-19 pandemic has created staffing problems across the health care sector.
But because state hospitals are publicly funded, they are not able to roll out incentive or bonus programs to keep employees around, such as a state-funded initiative to help hospitals retain nurses and other critical staff that was started in September.
"We've talked to the administration and said: 'Look, you need to incentivize some of this. You need to do some of the things that these private entities are doing to attract and keep people,'" LaFrenz said. "But you know, the problem is always the appropriations."
In July, the Kansas Department of Aging and Disability Services, which runs Osawatomie and Larned, announced its would use an increase in Medicaid funds to give almost 500 workers at Osawatomie, KNI and Parsons a raise of several dollars an hour. A subsequent move boosted pay for an additional 179 people, who were primarily in more management-centered roles.
Funds are in place to back those raises until the end of June 2022, Brunner said. And Sen. Richard Hilderbrand, R-Galena, said there would likely be interest in pursuing a raise when the budget is debated next year. Hilderbrand cautioned he would want to ensure any action would be fair to workers across the board.
"I just think anytime we are going to look at increasing pay for one person we need to make sure we are looking at everybody and everybody is being looked at, not just one sector," said Hilderbrand, who chairs the Senate Public Health and Welfare Committee.
‘We will always do what is needed to care for the people living at KNI’
Brunner credited the raises to an improvement in retention, particularly at KNI and Parsons, with the latter facilities seeing recruiting classes so large they need multiple conference rooms to hold them all during training.
At KNI, the facility-wide vacancy rate has dropped from roughly 33% in June to 26% currently, largely thanks to the pay changes, Superintendent Brent Widick said.
"As we begin to see more applicants and fewer employees leaving, we are hopeful we will see the vacancy rate for direct support workers continue to shrink," Widick said in an email.
In 2011, then-Gov. Sam Brownback pushed to close KNI in an effort to cut costs, with stated plans to move patients to a community-based setting, if possible. But he later reversed course after a tide of advocacy from families and their allies, who successfully argued the remaining residents had no place to turn.
Joan Kelley, vice president of the KNI Parent Guardian group, called KNI a "godsend" for her grandson, saying he was turned down by community providers before he was placed at the institute in 2008.
She was critical of Gov. Laura Kelly's decision not to include pay hikes requested by KNI and Parsons State Hospital in her 2021 budget but said the group was "grateful" KDADS had ultimately delivered assistance to staff there.
"A significant number of compassionate direct care staff have left employment at KNI in tears, having to choose how to best provide for their families or stay at KNI and continue to receive stagnant, dis-incentive wages," Kelley said.
The pandemic has brought a new kind of uncertainty for residents. While Widick said the facility aims to provide its residents as normal of a life as possible, he noted they often had trouble understanding why pandemic restrictions were limiting their activities and changing their routine.
"The people living and working at KNI are family, and we will always do what is needed to care for the people living at KNI and support each other," he said.
Department: Plans to lift admissions moratorium are forthcoming
Brunner told legislators KDADS wants to remove the longstanding pause on voluntary admissions at Osawatomie in December — a big ticket item long desired by lawmakers and the state's mental health community.
An agency spokesperson confirmed Thursday the plan remains to lift the moratorium by the end of the calendar year.
Legislators were so adamant the moratorium should end that they included language in the most recent budget requiring KDADS to change the policy, though Gov. Laura Kelly rejected the provision and Republican lawmakers didn't attempt to override her decision.
The moratorium dates back to 2015 and a citation from the Centers for Medicare and Medicaid Services that the facility wasn't doing enough to prevent suicidal patients from harming themselves. It came on the heels of a separate citation, with the hospital housing routinely three patients in rooms built for two.
A plan unveiled by the agency in 2020 required a building be renovated on Osawatomie's campus so as to increase its census while larger renovations take place. Efforts to provide options effectively allowing private psychiatric facilities to stand in for state hospitals also were considered to be essential for lifting the moratorium.
"Hopefully it gives us another relief valve to have patients treated and cared for in a way that is at that state hospital level of care, to get them more successful once the hospital has exhausted what they can do," Brunner said.
The moratorium has created problems for other mental health providers, law enforcement personnel and health care facilities, who are unsure of what to do with those in the throes of serious mental illness if admission to Osawatomie isn't an option.
“Prior to the moratorium, communities knew that individuals would be admitted to OSH when deemed necessary,” Matthew Atteberry, executive director at Labette Center for Mental Health Services, told a legislative committee last year. “Now those same communities and (community mental health centers) face the possibility that in any given situation admission may not occur for a significant amount of time."
Even when the moratorium is lifted, advocates warn structural problems will remain — the pay increases have been less effective at bringing in workers to Osawatomie, KDADS acknowledges.
"If you want to lift the moratorium, I mean, that sounds great," LaFrenz said. "But who's going to take care of those people?"
Andrew Bahl is a senior statehouse reporter for the Topeka Capital-Journal. He can be reached at firstname.lastname@example.org or by phone at 443-979-6100.