Wisconsin may be facing a health care crisis soon. And it isn’t because of COVID-19.
The pandemic created conditions similar to the impending “Silver Tsunami” of aging patients who, like the droves of coronavirus-infected patients filling hospital beds throughout 2020, could strain the state’s health care infrastructure within a decade, according to a report published Wednesday by the Wisconsin Hospital Association.
Wisconsinites are getting older, and fast. And the state’s health care workforce right now isn’t big enough to maintain the same level of care permanently.
The shortage isn’t so much caused by too few workers necessarily, but by the aging of those baby boomers, those born in the years 1946 to 1964. As the average age of an American trend upward, cumulative care needs increase as boomers reach their later years while younger generations simply aren’t big enough to supply the workforce under normal rates.
Citing data from the Association of American Medical Colleges, the WHA’s “Wisconsin 2020 Health Care Workforce Report” states that “from 2017 to 2032, the U.S. population under age 18 is projected to grow by only 3.5%, while the population aged 65 and over is projected to grow by 48%, and the population aged 75 and older is projected to grow by a staggering 75.3%.”
These trends will likely hold true in Wisconsin. According to state data, as of 2015, more than one-fifth of the populations of all but nine of Wisconsin’s counties were age 60 and older, and no county’s populations was more than two-fifths comprised of those 60 and over. By 2030, projections show that every Wisconsin county’s population is to be at least 20% people who are 60 and older, and 10 counties (all of them in central or northern Wisconsin) are to have 40% of their populations age 60 or older.
The strain this can put on health systems will be obvious. Citing data from the Wisconsin Institute for Health Aging, the Wisconsin 2020 Health Care Workforce Report states: “An aging population places greater demand on the health care system and requires a larger health care workforce. 80% of older people have at least one chronic condition, and 50% have at least two chronic conditions. Chronic diseases account for 75% of health care expenditures in the U.S. every year, and 95% of health care spending for older people is attributed to chronic conditions.”
Wisconsin’s hospitals received their first taste of these problems amid COVID-19, when limited workforces were stretched thin by fast-rising demand.
“Worker shortages were further exacerbated by a rapidly escalating surge of COVID-19 patients needing care in the closing months of the year,” wrote Debra Rudquist, chair of the WHA Council on Workforce Development and CEO of Amery Hospital & Clinic. “Underlying issues were brought to the forefront, as health care providers became the last line of defense for an overwhelmed public health and social support system fighting the spread of this virus.”
The report notes workforces facing “relentless overtime” in late 2020, the direct result of the seemingly unchecked spread of COVID-19 blamed on “COVID fatigue” and fewer people strictly following social distancing protocols.
“The workforce was stretched beyond its limits by COVID-19,” the WHA report states.
Among the biggest factors in the nursing shortage are “a large number of nurses retiring, and a large number of nurse-educators retiring,” said Victoria Hulback, dean of the Gateway Technical College’s School of Health.
It remains unclear how much damage the health care workforce will take as a result of medical professionals “burning out” and quitting because of the strain of the pandemic. But at least one nationwide survey from two California-based health care organizations, HOLLIBLU and Feedtrail, found that “of the 1,300 nurses surveyed, three out five are likely to leave their position or specialty as a result of their experience with the COVID-19 pandemic. Further data analysis shows that 67 percent of respondents will either leave their current facility or quit the industry altogether; and 3 percent of these nurses have already resigned.”
Typically, the turnover rate for registered nurses — i.e., the percentage of RNs at any given facility who are no longer at that facility the next year for any reason — is a little below 20% nationwide on average, according to a 2020 report from NSI Nursing Solutions.
Staffing agencies became a saving grace amid the pandemic, with hospitals filling their schedule holes with outsides workers, often from several states away. From 2008-19, Wisconsin’s hospital workforces were comprised of not more than 14.5% and not less than 3.5% of contracted staff. But the WHA doesn’t consider contractors to be a permanent solution.
Staffing levels at Wisconsin’s hospitals have grown over the last five years. In 2009, the Wisconsin “full-time equivalent” workforce (i.e. functionally how many full-time employees there are in Wisconsin hospitals) went from just barely over 95,000 “full-time equivalent” in 2009 to below 95,000 each of the next five years to spiking to more than 110,000 by 2019; more than half of that workforce is registered nurses.
However, according to a 2019 Hospital Personnel Survey, RNs remain in the highest demand. Statewide, 52% of vacant hospital jobs were for registered nurses, followed by certified nursing assistants at 12% and radiology technicians at 5%. The physician assistants’ vacancy rate spike to near 11% in 2015, but was down below 6% in 2019.
Aging also poses a dual threat, this time to the supply of hospital workers.
About 30% of certified registered nurse anesthetists are at least 55 years old in Wisconsin and thus nearing retirement. Licensed practical nurses and lab technologists trend even older. In 2013, more than one-third of Wisconsin lab technicians were 55 or older, although that number is now closer to 20%. About one in five respiratory therapists — literal lifesavers for some of the sickest COVID-19 patients — are also 55 or older.
Less than 4% of Wisconsin’s RNs were ages 65-74 in 2014, but in 2018 that percentage grew to 8.8% while the percentages of Wisconsin RNs ages 45-54 went from 24.5% in 2014 to 19.8% in 2018. WHA wasn’t alarmed by these changes since the percentage jumps weren’t super steep, but it would be a concern if young RNs don’t continual cycle into the workforce at the same rate.
The WHA’s report includes this statement on the situation: “COVID-19 accelerated historic trends that were already stressing Wisconsin’s health care workforce — most notably, an increasing demand for health care services by an aging population combined with disproportionate retirements of health care workers relative to new professionals entering the field, a phenomenon referred to as the ‘Silver Tsunami.’
“Wisconsin must continue to build our health care workforce to match demand and, at the same time, pursue strategies aimed at working more efficiently, leveraging new technologies to create better connections with patients and removing regulatory barriers that impede care delivery.”