Shutdown: Critical care dilemma

  • Article by: DEE DEPASS , Star Tribune
  • Updated: June 22, 2011 - 10:19 PM

Health care agencies are required to get criminal background checks from the state before hiring. But a shutdown would suspend the checks and freeze hiring.


JoeVon Shepherd requires continuous care from home health workers. Among the nurses who care for him is Liz Alvarado, who recently started work for ­Pediatric Home Service. If criminal background checks can’t be done, nurses such as Alvarado can’t start jobs with agencies such as Pediatric Home Service.

Photo: Glen Stubbe, Star Tribune

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Amy Nelson is trapped in a state shutdown conundrum.

The home health care company she founded in Elk River hires about 20 nurses and aides each week who care for a growing list of critically ill patients requiring 24-hour medical assistance.

If the state government shuts down next week, the state will stop processing the criminal background checks Nelson is required by law to make before hiring aid workers. And the state won't allow other agencies or private investigators to conduct the checks for her Accurate Home Care.

"That means that 80 people a month will not be able to get hired at $9 to $30 an hour. And that's just us," Nelson said.

It's enough to drive Nelson and others to worry. The home health care industry has high turnover due to the physical demands of the job. Many severely ill patients require three shifts of attendants to give round-the-clock care. New hires are critical.

"This will become very messy, very quickly," said Nelson adding that a shutdown could also delay state payments for the services rendered by her 1,200 Minnesota workers.

Multiply Nelson's scenario by the 1,573 licensed home health care agencies across the state and the potential for economic mayhem becomes apparent.

Jeremy Drucker, spokesman for the Minnesota Department of Human Services (DHS), said the department completed 37,966 criminal background checks for these agencies in the last fiscal year. But if the government shuts down July 1, background checks would stop unless the court intervened.

Bracing for trouble

"Under the contingency plan submitted by DHS to the governor, background checks would not be continued," Drucker said.

Officials at Pediatric Home Service Inc. in Roseville are bracing for trouble. They just launched a personal-nurse service, hired 70 nurses and plan to hire about 100 more.

"We have close to 15 to 20 cases that are just waiting for our service. We are interviewing anywhere from six to 12 nurses in a week and hiring three or four," said human resource director Todd Ericson. "If the government shuts down, we can't place them in the home and so they can't earn anything. ... Yet, these hires are incredibly important."

Critical care nurse Liz Alvarado recently joined Pediatric's staff and now works 12-hour shifts making sure 3-year old JoeVon Shepherd is safely and continuously fed through intravenous tubes because he can't absorb nutrients any other way. His feeding schedule runs 18 hours a day and requires several nurses.

To cover scheduling shifts, vacations, staff illnesses and other issues, Ericson needs to add scores of other nurses like Alvarado in the next few months to ensure there are no gaps in care for medically fragile patients like JoeVon.

An effect on employment

The timing of the state shutdown could create a crazy situation if it lasts long, Ericson said. Any forced short-staffing will hurt businesses industrywide, force some children back to the hospital or prevent newborns from leaving the hospital in the first place.

"It is us, as taxpayers, who ultimately pay that cost," Ericson said. "On average, it costs $1,600 a day to treat these children in their home. In the hospital, it is four to five times that cost."

Steve Hine, director of Minnesota's Labor Market Information Office, said that scenario "certainly would have an impact" on health care sector employment. How much is not known. It's one more situation in which "troubles mount" under the looming shutdown, Hine said.

If the state suffers a prolonged shutdown and doesn't solve the background checks and hiring problems, it risks undoing a full year of post- recession employment gains, economists said.

Minnesota's education and health care service employment grew by 7,400 jobs in the past 12 months.

Contractual obligations

Joan Vaughn said the state has put her small agency in a no-win situation. The founder and president of Communities of Care in Shoreview is contractually obligated to the state to provide care to her patients, 70 percent of whom are on ventilators. She also has to hire about five new home aides and nurses each month just to keep up with shift scheduling, vacations and turnover.

Yet if there is a shutdown, the state "would simultaneously be telling us, 'You have to do your jobs but we are not going to let you,'" Vaughn said. "This is a completely man-made, potential catastrophe and it's 100 percent preventable."

Dee DePass • 612-673-7725

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