Wisconsin’s growing worker shortage presents a particularly difficult challenge for the health care industry, especially in rural areas and at facilities that care for the elderly and disabled.
As Wisconsin’s baby boomers retire in greater number over the coming decades and live longer than previous generations there will be more consumers of health care while the working-age population that provides those services is projected to stay about the same.
“When we’re looking out 20 years, we need to think about policy actions we need to take now to meet (demand for services),” said George Quinn, director of the Wisconsin Council on Medical Education and the Workforce. “There are some significant things we have done, but there are other things we need to do.”
By 2024 there are expected to be nearly 52,000 more job openings than in 2014 in health care and social assistance fields — more than twice as many as the next largest sector, accommodation and food services — according to the Wisconsin Department of Workforce Development.
That means a greater need for both well-paid professionals such as doctors and nurses — registered nurses make on average nearly $68,000 a year — as well as lower-paid personal care workers and certified nursing assistants — jobs with average pay less than $30,000 a year. Competition, regulation and limited private and public funding limit how much providers can increase wages to attract more workers.
In Hudson, add to all those challenges the recent opening of a bridge over the St. Croix River, shortening the commute for Wisconsin workers to the Twin Cities, where wages for personal care workers can be about $1 per hour higher than in rural northwest Wisconsin due to cost of living differences.
“We were already short and people are continuing to build (nursing homes) in Wisconsin and Minnesota, creating a greater demand for workers,” said Ned Ammons, executive director of Red Cedar Canyon Senior Living.
Best of the worst
The worker shortage also means the quality of the applicants is suffering. Recently an employee at Options for Community Growth, which serves clients with disabilities in Milwaukee County, was arrested and charged with committing a string of armed robberies, according to human resources director Heather Hitchler.
“That kind of tells you where things are,” Hitchler said. “Trying to find someone who doesn’t have some kind of criminal background is next to impossible. Where our wages are at, people don’t want to work for that.”
Hitchler said some employees have trouble accessing transportation, especially when clients don’t live near public transit. Some employees are single mothers who won’t work certain shifts because they have children at home. Others only want a limited number of shifts because they don’t want to lose public benefits that disappear at a certain income level, she said.
Ammons sees many of the same challenges in the opposite corner of the state. He worries if nursing homes can’t find quality workers “more and more seniors are going to be turned away from assisted living.”
“I hate to say it, but you’re hiring the best of the worst,” Ammons said. “The cream of the crop are genuinely taken. No matter who walks through your door there’s one eye open about: ‘Why are you not working?’”
Between 2014 and 2024 the need for personal care aides is expected to grow 29 percent in Wisconsin, the highest percentage growth in the state. The need for home health aides is expected to grow 28 percent and for certified nursing assistants 13.4 percent.
In 2016 personal care aides were paid on average $22,400, less than what the United Way considers a survival wage in Wisconsin. In Minnesota the average is $24,610.
Bruce Colburn, vice president of politics and growth at SEIU Health Care Wisconsin, said low wages, not the workforce, are to blame for the shortage.
“(Low wages don’t) really help in terms of building a strong economy,” Colburn said. “Everything from housing to the kind of lives people lead. That’s an acute problem in Wisconsin. It’s mixed into the politics and people’s anger of what’s going on in the system. You work full time and you still have to live in poverty.”
The latest state budget, which has yet to be approved, increases funding for Family Care, the state’s long-term care program for low-income elderly, disabled and mentally ill, by $25 million. With matching federal funds, the move would add $60 million for worker raises.
Long-term care advocates say they are grateful for the additional funding, but the raises won’t solve the worker shortage. Caregivers are paid on average $10.75 per hour and the increase is expected to allow for a bump up to $12 an hour, said Jim Murphy, executive director of the Wisconsin Assisted Living Association.
Colburn is advocating for raising wages to $15, but also for creating career ladders so the lowest-paid personal care aides have clearer paths to become certified nursing assistants or eventually registered nurses.
Rep. Mike Rohrkaste, R-Neenah, one of the legislators who sponsored the pay increase in the budget, the K-12 system needs to be educating young people about career options in health care. The state also should be encouraging people in neighboring states to move here.
“Just by paying more isn’t necessarily going to solve the issue,” Rohrkaste said. “There’s more that could be done.”
Hospitals bracing for change
Wisconsin’s rural hospitals are also bracing for the growing worker shortage. By 2040, the number of counties in which seniors account for more than 30 percent of the population will total 27, up from zero in 2010, according to the Wisconsin Department of Administration Demographic Services Center.
“Is it a crisis? It could be if we don’t take care of it,” said Ann Zenk, vice president of workforce and clinical practice for the Wisconsin Hospital Association. “You see nursing shortages, but we can turn that around pretty quickly.”
As a sign of the growing need for health care in rural parts of the state, the Grant Regional Health Center is undergoing a $32 million 70,000 square-foot renovation and expansion.
“There’s a lot of holes out there,” CEO Nicole Clapp said in an interview looking out the window in her office.
The expansion will increase capacity for primary care specialists, emergency trauma and surgeries, expand the radiology department with the hospital’s first fixed MRI unit, and create a training facility to help meet the growing demand for providers.
Finding trained professionals to fill those positions can be a challenge in rural areas, but the hospital has come up with creative ways to address the need, such as providing a condo for a rotating list of UW Hospital surgeons to stay when they make the 90-minute drive out to Lancaster.
Nurses work in multiple departments, helping ensure they won’t lose hours in slow times. The hospital uses video technology to connect local stroke patients with neurosurgeons in Madison. Also the hospital has built connections with local schools and technical colleges through internship and residency programs.
One area, however, that remains more difficult than others to retain staff are in entry-level registration, housekeeping and food service positions, which pay between $9 and $14 an hour.
“It is hard to find that level of worker than you saw in previous generations,” Clapp said. “I would say the entry-level positions are where we have higher turnover. We compete with McDonald’s where you don’t have to work some of those undesirable shifts.”
The health care industry has been bracing for the looming baby boomer retirement for more than a decade and may be better positioned to absorb the growing worker shortage than other industries, said Morna Foy, president of the Wisconsin Technical College System.
Before the last recession health care providers worked with the technical college and university systems to build the pipeline for nurses. When the recession hit, that made it harder for students to land a job in their ideal
“A lot of health care providers will tell you they see a lot of opportunities on the horizon, but they are not as scared about being able to find the workforce because they have stayed connected to our schools and done a lot of recruiting,” Foy said. “They feel we have established nursing as a desirable profession.”
There are now efforts to alleviate the shortage of certified nursing assistants and home health and personal care aides by creating pathways for those workers to train into better-paid nursing positions.
“It’s one thing to take a job because you need a job, but it’s another to feel like you’re stuck there forever,” Foy said. “You can work hard and be a good employee and never make more than $15 an hour. We can’t control employers, but we can make sure the credentialing path is connected.”
Projected future job openings in Wisconsin, ranked by sector
*Salary based on local government jobs
Source: Office of Economic Advisors, Wisconsin Department of Workforce Development Bureau of Labor Statistics Quarterly Census of Employment and Wages
Sector Total new openings 2014-24 Percent growth in type of job Wisconsin average annual wage (2016)
Health care and social assistance 51,854 13.4 $46,043
Accommodation and food services 21,580 9.6 $14,754
Financial activities 12,461 8.3 $72,705
Construction 11,989 11.7 $58,774
Wholesale trade 10,610 8.9 $63,179
Professional, scientific, and technical services 10,517 10.5 $69,986
Management of companies and enterprises 9,393 16 $95,854
Other services (except government) 8,754 5.6 $28,060
Retail trade 7,572 2.5 $25,965
Administrative and support 7,507 5.2 $29,556
Manufacturing 5,839 1.3 $55,348
Transportation and warehousing 5,816 5.6 $41,234
Educational services (private sector) 5,676 1.5 $50,196
Information 3,851 8.1 $69,240
Arts, entertainment, and recreation 3,101 7.4 $27,382
Agriculture, forestry, fishing and hunting 2,032 1.9 $33,784
Real estate and rental and leasing 1,568 6.5 $40,121
Mining 773 22.9 $61,870
Government* -824 -0.5 $41,236
Utilities -843 -8.2 $96,988
0ecadae0-e3c2-5c4d-8c94-feab519d0142Projected future health care job openings in Wisconsin
Source: Office of Economic Advisors, Wisconsin Department of Workforce Development Bureau of Labor Statistics Occupational Employment Statistics
Occupation Tota new openings 2014-24 Percent growth in type of job Wisconsin average annual wage (May 2016) Typical education for entry Related occupation work experience On-the-job training needed for competency
Registered nurse 5,327 9.5 $67,930 Bachelor’s None None
Nursing assistant 4,578 13.4 $27,980 Postsecondary non-degree None None
Home health aide 2,051 28 $26,120 No formal None Short-term
Medical assistant 938 8.3 $34,740 Postsecondary non-degree None None
Pharmacy technician 729 10.1 $31,190 High school None Moderate
Physical therapist 616 13.3 $77,870 Doctoral or professional None None
Nurse practitioner 440 18.1 $98,250 Master’s None None
Licensed practical, licensed vocational nurse 401 4.6 $43,820 Postsecondary non-degree None None
Medical records, health information technician 395 8.1 $41,280 Postsecondary non-degree None None
Physician, surgeon 376 6.4 $251,400 Doctoral or non-degree None Internship, residency
Projected future job openings in Wisconsin, ranked by sector
*Salary based on local government jobs
Source: Office of Economic Advisors, Wisconsin Department of Workforce Development; Bureau of Labor Statistics Quarterly Census of Employment and Wages
|Sector||Total new openings 2014-24||Percent growth in type of job||Wisconsin average annual wage (2016)|
|Health care and social assistance||51,854||13.4||$46,043|
|Accommodation and food services||21,580||9.6||$14,754|
|Professional, scientific, and technical services||10,517||10.5||$69,986|
|Management of companies and enterprises||9,393||16||$95,854|
|Other services (except government)||8,754||5.6||$28,060|
|Administrative and support||7,507||5.2||$29,556|
|Transportation and warehousing||5,816||5.6||$41,234|
|Educational services (private sector)||5,676||1.5||$50,196|
|Arts, entertainment, and recreation||3,101||7.4||$27,382|
|Agriculture, forestry, fishing and hunting||2,032||1.9||$33,784|
|Real estate and rental and leasing||1,568||6.5||$40,121|
Projected future health care job openings in Wisconsin
Source: Office of Economic Advisors, Wisconsin Department of Workforce Development; Bureau of Labor Statistics Occupational Employment Statistics