Navigating The Challenges of Staffing Rural Facilities

Rural and critical access facilities offer special staffing challenges.

Rural facilities are among the most likely to have chronic staffing shortages. These facilities have special situations related to their geographic location. Hospitals and rural facilities are closing due to added cost of operations. This further compounds the problem and limits access to much-needed healthcare for the population in rural areas. 

Studies like this one on Challenges and Solutions to Accessing Long-term Care in Rural Areas are showing that rural facilities are also tasked with providing care for sicker patients with fewer resources. “Henning-Smith says the report shows that, in addition to workforce shortages, rural long-term care facilities have a hard time meeting demand because patients tend to be older, sicker, and poorer when compared to urban residents. The study also noted that some health conditions — such as psychiatric disorders, dementia, obesity, and those requiring medically intensive treatment — were particularly difficult to address.”

Even CMS (Centers for Medicare and Medicaid Services) are recognizing that staffing a rural facility is not a one-size-fits-all. “The CMS also chose not to mandate the presence of RNs at these facilities, despite evidence of greater acuity of illness among residents today and research findings of care deficiencies. The CMS rejected what it termed a “one size fits all” approach to addressing care deficiencies related to staffing, noting that mandating RNs 24/7 could be challenging in rural areas where there is a shortage of nurses.”

According to this article on rural nursing home closures, some of these considerations are:

  • Isolation from other population sources leading to lower occupancy and staffing options
  • Lack of Local Advancement Opportunities
  • Limited locations for Employment (results in the same staff leaving and returning from a few facilities in a geographic location. 
  • RN coverage is a challenge for these facilities as many RN’s staff local hospitals which do not employ LPN’s
  • Rural areas have a higher population of elderly and chronically ill.
  • The acuity is higher due to limited healthcare options
  • Lower reimbursement and higher costs 

Tips for staffing rural facilities:

  • Incentivize retention with annual increases and creative options for senior staff 
  • Offer professional development opportunities - cover the cost or partial cost of attending local LPN or other clinical programs like therapy assistant, respiratory therapy, etc.
  • Offer an AIT (administrator in training) program
  • Add RN’s for acuity, layered as a team model with LPN’s
    • Use job titles like “Post-Acute Rehab RN”
  • Partner with local healthcare providers, physicians, hospital, and home health for smooth transitions programs like this one at Mayo Clinic that increases census AND staffing
  • Get competitive with salaries. 
    • Compare the cost of agency use and open positions versus a salary increase.
  • Reconsider sign-on bonuses in lieu of a base salary increase or shift differential for difficult-to-fill shifts like 3-11 pm.
  • Consider an innovative approach to your staffing matrix that better meets facility needs
  • Seriously consider the culture and environment for employees at your rural facilities. 

Need more? This article on Recruiting for Retention in rural areas includes other ideas including recruiting for physicians and other practitioners as well. 

If you still need help with staffing your rural facility, schedule a call, and let’s discuss your needs to determine if we can help. We work directly with the facility and corporate leadership to change the mindset and approach to staffing in an intentional manner with amazing outcomes for residents and revenue.

Our facility stabilization program was designed for a facility like yours.

Categories: Operational Excellence, Staffing Stability

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