Health care providers have made progress on one of the most acute shortages in Massachusetts, with a new survey suggesting a number of desperately needed inpatient psychiatric beds have been added over the last 18 months. Yet a seemingly intractable labor shortage continues to undermine any momentum within the industry, with hundreds of other beds ready but unavailable because there aren’t enough workers.
The survey by the Massachusetts Health & Hospital Association and the Massachusetts Association of Behavioral Health Systems found that 19.9 percent of inpatient psychiatric beds at surveyed facilities were offline due to staffing shortages. That’s up from 9 percent in February 2021.
The results underscore the difficulty of making progress on a crisis that has rippled through the health care system. With tens of millions in state aid helping to boost salaries and ramp up recruiting, psychiatric facilities have made a concerted effort to increase capacity and reduce the lengthy waits for an inpatient bed for seriously ill patients. So while there are now more psychiatric beds than a year and a half ago, about 130 by one count, that doesn’t necessarily mean more patients are getting necessary care. Indeed, among the facilities in the most recent survey, for example, officials say there are 568 that remain empty because they don’t have the staff for them.
The backup caused by the lack of staff is forcing some patients to spend days, in some cases weeks, in hospitals waiting for a bed at a psychiatric facility to become available. As of Sept. 12, there were 679 patients — including 87 pediatric patients — waiting for a psychiatric bed in 53 surveyed hospitals, the two groups said.
“I’ve talked to my hospitals, and asked, ‘Could we cut down on the staffing requirements?’ Because we can’t fill these spots,” said David Matteodo, executive director for the Massachusetts Association of Behavioral Health Systems. “But there is no way. It wouldn’t be safe. We’re in a real bind.”
Matteodo said the industry is not only having difficulty recruiting people to the profession, but retaining them, as telemedicine is drawing behavioral health clinicians away from the more challenging front-line work. Others have retired or left the field entirely after assessing their careers during the pandemic.
Moreover, Matteodo said the work has become more difficult, with larger numbers of more severely ill patients showing up after being disconnected from resources during the pandemic or experiencing heightened mental health conditions.
The survey also found that the most acute shortages were among registered nurses and mental health workers with bachelor’s degrees who perform front-line care under the supervision of a nurse. The facilities surveyed indicated they need at least 500 more of those front-line mental health workers, and have nearly as many open positions for registered nurses. They also report dozens of job vacancies for social workers, sitters, certified nursing assistants, and psychiatrists.
Several facilities have been able to add new beds or have announced plans to do so. Even so, the survey data suggests that the state has lost some of those gains since late last year because of the workforce shortage. While reporting facilities were not always the same, participants reported more staffed beds available last October — 2,319 — than in August 2022.
The deteriorating staffing levels came despite millions in state aid. In July 2021, Governor Charlie Baker announced his office would provide $31 million to inpatient psychiatric acute care facilities. That money was used to increase staff wages, and offer sign-on and retention bonuses. Funding was released in the fall of 2021 and early 2022.
Leigh Simons Youmans, senior director of Healthcare Policy for the Massachusetts Health & Hospital Association, said the money has made a difference, helping to preserve staffing levels during the Delta and Omicron COVID-19 surges. Without it, she said, the staffing crisis with inpatient psychiatric beds would have been even worse.
Advocates are now hoping to tap into a new $198 million behavioral health trust fund that was established with federal pandemic aid, and use the money to expand scholarship opportunities and loan forgiveness. The money could also be used to train workers in behavioral health, substance use disorder, and trauma-responsive skills at places like skilled nursing facilities and group homes, which often send patients with those needs to hospitals.
Youmans said recruitment and workforce development efforts in the past have focused on those with master’s degrees or higher. But knowing of the huge need for front-line workers who just need a bachelor’s degree will help groups advocate for where to allocate additional resources.
MHA has also been advocating for the creation of a task force that would look at redesigning reimbursements for behavioral health work.
Matteodo noted that the state’s Medicaid program was also actively working to change reimbursements, and had developed a new system, set to go into effect in October, to pay hospitals higher rates if they take behavioral health patients who are more difficult to place, such as children and geriatric patients.
“But clearly [higher] reimbursements are something we need, just to keep up with the rest of the economy,” Matteodo said.