Minnesota lawmakers introduce bill to help with home health nurse shortage

On Wednesday, Minnesota lawmakers introduced legislation aimed at addressing shortages in home health care nurses.

It’s a problem Minnesota families who have children with complex medical needs have been dealing with for some time.

According to the Minnesota Home Care Association, there are at least 1,000 families looking for home health nurses.

5 EYEWITNESS NEWS first reported on the issue back in January while speaking with the family of Jamie Craven, who is now a year old. He’s spent his entire life in the Neonatal Intensive Care Unit at M Health Fairview’s Masonic Children’s Hospital, despite having been cleared by doctors to go home back in September.

He’s spent the last 6 months stuck in the hospital because his family is unable to find the home health nurses needed to care for Jamie at home.

After Jamie’s story aired, another Minnesota mom reached out to 5 EYEWITNESS NEWS. Linda Trepanier is the mom of five medically fragile children, and she said the problems don’t stop even when families are able to go home.

Trepanier is a pediatric critical care registered nurse who worked in home health care for years. After raising her three biological children, she adopted five more children who all have intensive medical needs.

“Four of them need one-to-one home health nurses,” Trepanier said.

That care, Trepanier said, is hard to come by and even harder to keep.

Her 10-year-old son, Ethan, has a condition called Hydranencephaly.

“[That] means he actually doesn’t have a brain. He really only has a cerebellum and a brain stem,” Trepanier explained.

Ethan needs around the clock care – he has a tracheostomy to help him breathe, a feeding to tube to eat and he also needs to be turned every two hours to prevent bed sores.

So when Ethan’s nurse called in sick for her Thursday shift, Trepanier was left scrambling.

“We don’t have anybody to cover the shifts as it is… we just kind of have to try and make it work,” she said.

“Families are at a tipping point,” said Cameo Zehnder, the chief administrative officer at Pediatric Home Service, which provides home health care services for children with medical complexities across the state.

Zehnder said agencies like hers don’t have the staff to keep up with patient needs.

“It is definitely a challenge to first attract those nurses because even at the starting wages at the hospital, it’s not a competitive wage,” she said.

On average, home health nurses make 35% less than nurses in a hospital setting. When you factor in the bonuses and incentives hospitals can offer, that disparity is even greater. That’s because agencies are locked in when it comes to how much they can pay nurses based off of set reimbursement rates.

Zehnder said their goal is to staff each child’s care at a minimum of 90%, but because of the shortage, that’s not happening.

“Today our average is hovering around 60%. So, 60% of the child’s physician ordered nursing hours are met, meaning 40% are not. We have some families where their schedules are billed to as low as 35% and what that means is families are filling in the gap,” added Zehnder.

Trepanier said she’s only able to manage her kids’ needs because of her medical background. But many families don’t have that same experience.

“They’re not nurses like me. A lot of them are parents who love their children and have been taught their cares but are very, very afraid if something went wrong and they didn’t have a nurse there that it would cost them their child’s life,” Trepanier said.

In many cases, the staffing shortages are leading to unsafe situations in the home.

“When we don’t have nurses, we can’t ensure a safe care plan, so for the health and safety of the child may be to have that child re-admitted to the hospital,” Zehnder said.

S.F. 1830 and H.F. 2087 are nearly identical bills that would increase reimbursement rates for home health nurses by 55 percent. Senator John Hoffman (DFL- Champlin) authored S.F. 1830 and said these changes are long overdue.

“Home care nurses deserve payments that align with their skill set and not the environment of where they practice,” Hoffman said, “It costs more to keep kiddos in the hospital than it would at home. That’s their natural environment.”

If passed, this legislation would take effect July 1, 2023. Zehnder said increased rates would allow agencies like hers to recruit and retain staff.

“What it will mean is we’re able to extend that competitive wage to nurses,” she said.

Trepanier adds more nurses in the workforce would allow for her children to remain safely at home.

“I think that every medically fragile child deserves to have the best opportunity to be the best that they can be.”

The Senate’s bill had a hearing Wednesday where it was met with bi-partisan support. Before the hearing, families this would impact gathered to offer their own support and pleas.

“Our family relies on home care nursing,” Tiffany Goodchild, whose son needs at-home care and was the driving force behind the Kourageous Karter Foundation, said. “[It’s] truly the difference maker in our family and we have felt the effects of the shortage in a big way.”

Joining them outside the hearing was pediatric pulmonologist with Children’s Hospital’s talking about the impact this could have on time families have to spend in the hospital waiting for at-home care.

“[Thursday] we’ll discharge a patient from Children’s who waited 120 extra days to be discharged to home due to a lack of nursing care,” Dr. Brooke Moore with Children’s Hospital said, adding: “That’s four additional months of unnecessary time in the hospital.”