Staffing crisis at Kansas mental hospital deepens. What will lawmakers do next session?
Katie Bernard
Thu, December 15, 2022 at 5:00 AM·8 min read
Last year, as law enforcement and staff raised alarms that Larned State Hospital, Kansas’ largest psychiatric facility, had reached a “crisis level” of understaffing, Gov. Laura Kelly rolled out pay raises.
The Democratic governor’s plan included an across-the-board increase for workers in the state’s 24/7 facilities, as well as additional pay that would kick in based upon staffing levels.
A year later, the situation in Larned has only worsened. Nearly six out of every 10 positions are vacant as the state confronts a deepening workforce shortage that is particularly acute in a rural state hospital that requires grueling work from its staff.
To fill the gaps, Kansas spent more than $28 million on contract nurses at Larned in the last fiscal year. Meanwhile, the state lacks the beds to fill the mental health needs of Kansans and is exploring opening an additional state hospital near Wichita.
Larned plays a crucial role in Kansas’ mental health infrastructure serving state residents while also managing patients ordered to the hospital by a court for treatment or psychiatric evaluations. Adequate staffing is essential to ensuring the hospital can operate at full capacity and ensure the safety of staff and patients alike.
As lawmakers prepare to return to Topeka next month for the Legislature’s annual session, they’re weighing both short and long term changes.
The Kansas Department of Aging and Disabilities, the agency that oversees Larned State Hospital, says it has taken numerous recruitment steps including advertising positions at universities and local workforce centers. Recently the state signed a contract with KSN in Wichita for TV advertisement of the openings.
“Finding trained medical staff is very difficult for every medical facility across the country right now. The pandemic has caused major issues within the medical community that will take time to address – which is a global issue,” Cara Sloan Ramos, a spokeswoman the agency, said in an email.
“The staffing concerns at Larned is further compounded by its rural location of the hospital.”
Laura Howard, left, the top social services administrator in Kansas state government, discusses a plan to merge two agencies as Gov. Laura Kelly, right, watches, during a news conference, Wednesday, Jan. 8, 2020, at the Statehouse in Topeka.
Staffing challenges deepen
One of the challenges for Larned in particular is its location. Larned is a small town with a population fewer than 4,000 located 120 miles Northwest of Wichita. It is a difficult area to recruit workers to.
William Nusser, the mayor of Larned, said there’s efforts within the community to recruit workers including housing developments going up around town. But he doesn’t know if it’s enough.
“When I first started getting involved in the state hospital my theory was I’m giving a 10 foot ladder. I just don’t know if we’re in a 20 foot hole,’” Nusser said. “There’s so much mental health demand and we’re working hard.”
Nusser said the staffing problems at Larned started with former Republican Gov. Sam Brownback. Under his administration wages froze at the hospital for years. Pay for state workers quickly fell below market rate and workers began to leave.
In Nusser’s view, the situation was finally improving after Kelly was elected. Then, the pandemic hit.
“People are just burnt out,” he said.
COVID-19 left lasting damage on healthcare workforces nationwide in the private and public sector. Nursing shortages became common across the industry as staff members retired early and left the field. There weren’t enough new employees to fill the gaps.
Kansas emerged from the public health crisis facing an ever deepening workforce shortage. While Kelly’s administration has focused energy on job creation; the state’s unemployment rate was at 2.8% in October, according to the Kansas Department of Labor.
Kansas’ workforce is retiring and young people are, by and large, choosing to leave the state rather than stay and take jobs close to home.
In Larned State Hospital the situation became dangerous.
In the past two years the hospital made headlines for inmate escapes and injuries to staff members. Understaffing, said Sarah LaFrenz, president of the state workers union, contributes to safety concerns.
“You don’t know who’s on there with you. You don’t know how many people you’re going to have. If patients are stirred up or upset about something it makes them harder to handle,” she said. “There’s a higher ability to be assaulted at work.”
To fill the gaps the state has increased spending on agency contracts. According to KDADS the spending increased from $12.1 million in fiscal year 2021 to $38.1 million in fiscal year 2022. Roughly three quarters of that spending was on staff for Larned State Hospital.
Sloan Ramos said the department is planning to request additional funding for the next two fiscal years to sustain the contracts.
But the contracts created a new problem where state employees are working side by side with agency staff getting paid two to three times more to do the same job. It could harm the state’s ability to recruit and retain staff.
Kansas House Appropriations Committee Chair Troy Waymaster, R-Bunker Hill, speaks with reporters following a budget briefing from Democratic Gov. Laura Kelly’s budget director, Wednesday, Jan. 12 at the Statehouse in Topeka.
“Contract nursing is very enticing because you have a very high rate of pay even though there’s no benefits that’s really associated with that. There’s been a concern even with our hospitals across the state, our other healthcare facilities, the contract nurses go into the hospitals and kind of, in a way, recruit other nurses to do the same thing,” said Rep. Troy Waymaster, a Bunker Hill Republican who chairs the House Appropriations Committee.
“I don’t see it going away, the need for the contract nurses.”
Nusser said pay increases are needed to bridge that gap.
“People are expecting $20 minimum,” Nusser said. “You can’t be at $13.81 and expect your staffing problems to ever get any better.”
But LaFrenz and Lynette Delaney, a union steward for Larned, pointed to broader cultural issues.
Agency staff, LaFrenz said, get better hours than state employees and don’t have to work overtime. State employers, she said, are “being overworked what I would term as to death”
Delaney said staff that have remained aren’t treated well by middle management.
“You get a target on your back, especially if you file grievances or you stand up and fight for your rights,” she said.
LaFrenz worried plans to build a new state hospital in the Wichita region would only exacerbate the problem.
“It’s going to be really difficult right now to say ‘yep that’s the answer’ because if you can’t staff one how do you plan to staff the other,” she said.
Lawmakers plan to approve $50 million in federal COVID-19 relief dollars to build a 50 bed facility in the region.
It’s a project state Sen. Carolyn McGinn, a Wichita Republican, has been pushing for for years because the state’s largest city has no nearby state mental health facility. She and other lawmakers said Wichita will provide a broader labor force than Larned has.
“We have enough people here in our own region that we can handle it,” she said. Furthermore, she added that it would help alleviate wait lists for existing state hospitals.
Lawmakers consider solutions
As a short term solution, Waymaster said the state needs to start considering pay increases on a facility by facility basis, rather than the blanket raises that have been traditional in state government.
“We need to start looking at this in individual areas, in every single facility we have,” he said. “We need to start assessing the different environments for each of our facilities like they do in private business.”
Zach Fletcher, a spokesman for Kelly, said the governor’s next budget would include proposals for recruiting and retaining staff across agencies but gave no details.
“State employees are critical to our public safety and the services provided to Kansans. Just like businesses across the country are doing, the Kelly administration continues to explore ways to attract and retain a qualified workforce for all of our current vacancies, including at our state hospitals,” Fletcher said in a statement.
One thing Kelly’s budget is all but certain to include is the governor’s fifth consecutive proposal to expand medicaid. Kansas is one of just 11 states that has not yet expanded the program. But leaders in the Republican supermajority of the Kansas Legislature are adamantly opposed to the policy.
Sen. Tom Hawk, a Manhattan Democrat, said additional funds that would come from expansion could help the state serve Kansans before they reach the state hospitals and ensure the hospitals themselves have adequate resources.
“We need to stop playing with that issue and recognize that it’s one of the solutions, not the whole solution,” he said.
Kansas state Rep. Brenda Landwehr, R-Wichita, speaks with reporters following a legislative committee meeting on federal vaccine mandates on Oct. 29, 2021, at the Statehouse in Topeka.
Rep. Brenda Landwehr, a Wichita Republican, has advocated for finding avenues to lower requirements for professionals seeking jobs in the hospital and consider whether the state is requiring too many hours of classes for some positions.
In addition to seeking short term solutions, discussions are underway on how to remedy the situation in the long term.
An interim committee on mental health beds recommended the state establish a scholarship program for students that commit to working at the state hospital after graduation.
McGinn said the long term solution involves getting students interested in healthcare at a young age and establishing incentives for them to stay in Kansas. In addition to scholarships, McGinn said, that includes work to establish programing in career and technical colleges and within junior high and high schools.
“We’ve got to start a new pipeline and introduce the next generation to healthcare. One of those areas happens to be mental health,” she said.
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