(The Center Square) — Despite funding for chronic shortfalls in the North Carolina Department of Health and Human Services during the last legislative session, the department continues to struggle with long waitlists and chronic staff turnover.
DHHS Secretary Kody Kinsley updated lawmakers on the department’s finances and services during a hearing in the Joint Legislative Oversight Committee on Health and Human Services on Tuesday.
Kinsley thanked lawmakers for recently appropriated funds to mitigate chronic shortfalls at state operated healthcare facilities, in the information technology budget, at the Office of Chief Medical Examiner, and to support labor market salary adjustments across the department.
But he warned of a looming “cliff” for an array of services that are currently propped up with federal COVID funding, including money for childcare providers, child care teacher supplements, enhanced Medicaid rates for skilled nursing facilities, services for older adults, energy assistance for low-income families and other supports.
“One key area I would like to highlight … is the cliff we will see around funding for the childcare workforce. We know the margins for child care are incredibly tight,” Kinsley said, noting $800 million in federal subsidies to help families afford child care. “When this money fades off over the next several years, I think we’ll get to a point where teachers will not be able to stay, their incomes will shift, or parents will not be able to pay.”
“In addition to negatively impacting children, … it’s also a real impact to our workforce. Parents saw this during COVID. If parents can’t find a place to care for their kids, they can’t show up to work,” he said.
Kinsley also discussed the department’s struggles with long waitlists for many programs, which total 15,689 on the state’s Registry of Unmet Need.
The waitlists include 488 at the Community Alternatives Program for Disabled Adults, 6,000 on the North Carolina Child Care Subsidy Statewide waitlist, 472 waiting to enter state facilities and 248 waiting for spots at State Psychiatric Hospitals.
“A lot of folks are ending up in (emergency departments) because they don’t have anywhere else to go,” he said. “A core factor that drives a lot of these waitlists, especially around our state facilities, is our vacancy rate” for employees.
“Our department’s vacancy rate has doubled since COVID,” Kinsley said, going from 12.7% in March 2020 to 23.2% in July 2022.
Those vacancies include a 30% rate or 1,358 vacancies in healthcare technology, 42% or 46 vacancies for psychologists, 44% or 68 vacancies for clinical social workers, and 44% or 411 vacancies for registered nurses.
“While those gaps are growing, we have no choice to try to find a balance and use some of that lapse salary dollars for contract staff,” Kinsley said. “Contract staff employees tend to be two to three times more expensive than a state staff person.”
Kinsley said the state has spent about $65 million on contract staff so far.
The 12-month turnover rate for the department has also increased from 22.6% in March 2020 to 34% in July 2022, with an average turnover at state facilities at 45%. The nurse turnover rate at the Division of Health Service Regulation is now over 55%. The highest turnover rate in the state is at the Black Mountain Neuro-Medical Center, with a rate of 72%, Kinsley said.
The situation means increased waitlists, increased time on waitlists, increased need for services, and fewer people served. The number of people served at state psychiatric facilities has declined 28% or by 2,341 people in recent years, from 8,423 in fiscal year 2019 to 6,066 in fiscal year 2022.
“All because we can’t maintain the staff to patient ratios,” Kinsley said. “Many of these people not in state psychiatric hospitals are staying in local emergency departments or they’re ending up in law enforcement’s custody, or they’re ending up homeless or in a number of other spaces, which is a lose, lose, lose for everybody.”