November 2000

Background

In October 2000, the MH/MR Coalition* conducted a survey to gather information about the costs related to recruitment and retention problems in the provision of MH/MR services. This survey was a follow up to the Coalition's 2000 Staffing Survey (June-July 2000), which provided a picture of the recruitment and retention problems that providers and counties were experiencing and elicited the solutions that they were applying to these problems.

Survey Purpose

The purpose of the Follow-up Survey was to quantify the financial costs to counties, providers, and payers that are generated by the lack of a stable workforce in the MH/MR arena. This survey can only quantify the dollar costs. The purpose of the Follow-up Survey was to identify the costs to providers and counties due to recruitment and retention problems. The significant personal and emotional toll that results from an over-worked, constantly changing workforce are not discussed. They cannot be easily quantified.

Composition of the Group Surveyed

The survey was mailed to members of organizations in the MH/MR Coalition. There were 127 total respondents, although not every respondent answered every question. The composition of the agencies that responded to the survey is as follows:

Service Areas

20% provide MH services only
31% provide MR services only
49% provide both MH and MR services

Geographical Areas

27% serve rural areas only
19% serve urban areas only
54% serve both rural and urban areas

Location of Facilities

(Total exceeds 100% due to agencies that serve more than one region of the state)
Southeast 29%
Northeast 24%
Central 35%
Western 36%

Survey Responses

Between 1998 and 2000, agencies and counties document

• A 58% increase in the number of hours of vacancies in direct care positions; to fill these hours, an equivalent of 3580 full time workers would be required.
• A 34% increase in the hours of overtime worked; to eliminate use of overtime, an equivalent of 5441 full time workers would be required.
• 90% of the agencies have had to increase the amount of money that is spent on classified advertising.
• Three-quarters of the positions remain unfilled for up to three months.

Agencies also noted that the supervisory staff has had to increase the amount of time in which they provide direct care. Eight one percent of agencies stated that there has been an increase in the overtime hours worked by supervisory staff since 1998. In order to serve clients, almost half of the agencies responding noted that they have turned to temporary staffing services to meet staffing needs.

Staffing problems have also affected the training provided to direct care workers in one out of six agencies in 2000. Organizations that reduced training cited need to cover vacancies and budget constraints as factors leading to reduction.

Respondents indicated that the staffing shortage has an impact on delivery of services. The survey indicates that

• 38% – almost two out of five of the providers responding to the survey – has been unable to periodically deliver services between 1998 and 2000 due primarily to staffing shortages.
• Half of the providers slowed or stopped some services in 2000, citing staffing shortages as the primary cause.
• Half of the providers indicated that they have had an increase in the number of on-call emergencies since 1998, and those experiencing an increase in emergency calls identify staff vacancies as a primary reason for the increase.

Conclusion

In conclusion, survey responses indicate that the added cost of services generated by the current MH/MR staffing crisis is an inefficiency that drains valuable financial resources from an already strained system. The Follow-up Study paints a portrait of a system that uses temporary workers to fill demanding jobs, relies on increasingly on overtime work by regular staff, and the uses supervisory personnel to provide direct care in addition to their managerial duties. And the staffing vacancies are having an impact on services. If Pennsylvania is to continue its laudable record of downsizing institutions and placing persons in community settings, the inefficiency and high cost of providing services in this manner must be addressed.

*The MH/MR Coalition consists of statewide associations that represent mental health and/or mental retardation provider agencies and counties in Pennsylvania: The ARC-PA, Mental Health Associations of PA, MH/MR Program Administrators of PA, Pennsylvania Association of Rehabilitation Facilities, Pennsylvania Association of Resources for People with Mental Retardation, Pennsylvania Community Providers Association, and United Cerebral Palsy of PA.

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