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The Consequences of Using a Nurse Assessment Coordinator as Interim Clinical Staff<p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/JenniferLaBay.jpg" alt="Jennifer LaBay" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />​The nurse assessment coordinator (NAC) has a unique, highly specialized role in the skilled nursing facility (SNF) post-acute care setting. The NAC must possess knowledge that combines clinical, financial, and regulatory compliance information. From the <em>Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual </em>to the<em> Nursing Home Five-Star Quality Rating System&#58; Technical Specifications</em> and all the related regulations in between, there are thousands of pages of federal regulation and guidance that the NAC must understand to succeed in the role—not to mention any state-specific requirements for minimum data set (MDS) coding and Medicaid payment. Because the position is so specialized, clinical leadership must weigh the risks of utilizing the NAC to cover open nursing positions against the benefits. While temporarily shifting the NAC to an open spot may solve an immediate problem, it could also negatively affect reimbursement, quality outcomes, and the facility’s Five-Star rating. </p><h3>Medicare and/or Medicaid Revenue</h3><p>The MDS drives payment for Original Medicare using the Patient-Driven Payment Model. This system consists of six components&#58; five case-mix adjusted and one non-case-mix. The five case-mix-adjusted components derive almost exclusively from MDS coding. The NAC must be not only well-versed in the MDS coding instructions but also aware of the case management intricacies involved in assessment reference date (ARD) selection and Interim Payment Assessment determinations. Both of these factors can have a significant impact on a facility’s bottom line. <br></p><p>In case-mix states utilizing the legacy payment systems, the MDS drives Medicaid payment as well. A NAC working the floor is not managing the Medicare or Medicaid caseloads. When finally able to complete the MDS, he or she may not have adequate time for a comprehensive review of supporting documentation. This can lead to overlooking details, such as missing documentation to support intravenous fluids, selecting the wrong ICD-10-CM codes as the primary diagnosis, or not timely setting the ARD. All of these mishaps can lead to loss of revenue or provider liability. Who manages MDS responsibilities when the NAC is working the floor? If the facility is lucky enough to have someone covering the NAC’s duties, does that person have the knowledge to do it correctly? Does the substitute know the MDS coding instructions? Is he or she aware of the timeliness requirements for setting ARDs appropriately? Is the facility following ICD-10-CM coding guidelines? These are important questions to consider when attempting to manage the staffing crisis by utilizing the NAC in other roles.</p><h3>Quality Measures </h3><p>Quality measures (QMs) affect many aspects of the SNF world; they drive the facility’s quality improvement efforts, influence the survey process and the Five-Star rating, and are publicly reported for consumers. There are some claims-based QMs, but most of the measures are directly based on what is coded on the MDS. If there is a delay in completing assessments due to a staffing issue, rushing to complete assessments may cause inaccuracies when insufficient time is invested in researching records. Or inadequate training of the person completing assessments can lead to inaccurate coding, as well. It is important to monitor the QMs closely when backup NACs complete assessments to identify any errors and make modifications timely. </p><h3>Five-Star </h3><p>QM reports found on the CASPER and Care Compare websites contain historical data, so facility leadership may not immediately see the effects of their staffing decisions. Publicly reported and Five-Star QMs present four quarters of data, but because there is a full quarter of lag time in reporting, the data on these reports are 6 to 18 months old. Once the QMs are calculated for public reporting, facility staff cannot make any corrections to change the data. So the only things that can shift QM numbers are the passing of time, accurate assessments moving forward, and quality improvement efforts. <br></p><p>Additionally, the staffing star rating uses MDS data to determine the census for hours per resident day calculations. If discharge assessments are not completed in a timely manner, the facility census will appear larger in the Five-Star census than it actually is at the facility. This can result in the publicly reported staffing calculation showing that the facility is not staffing adequately for the census, when in reality, the MDS census was incorrect due to missing discharge assessments. <br></p><p>The QM and staffing ratings also affect the overall Five-Star rating. If a facility is rated at five stars for staffing, a star would be added to the overall star rating. If the facility has a one star in staffing, even if due to incomplete discharge assessments, this would subtract one star from the total. If a facility is at five stars for QMs, it adds a star to the overall star rating. Dropping to four QM stars or less due to a lack of oversight and management of the MDS process harms the overall star rating. Moreover, if a facility already not performing well with QMs drops from a two-star rating to a one-star in QMs, the facility will lose a star in the overall star rating. </p><h3>Managing MDS and Medicare Compliance</h3><p>Therefore, before turning to the NAC to cover an open shift, nursing home leadership must consider how that vacant or inadequately filled position will affect the facility in the long run. <br></p><p>However, when there is no alternative and the NAC must be used to provide resident care, there are some steps leadership can take to reduce declines in quality and revenue. Ample cross-training of duties by incorporating Resident Assessment Instrument (RAI) requirements and definitions into interdisciplinary team assessments positions more staff members to contribute to the MDS process. Leadership can also optimize facility software, when possible, to prompt nursing staff for documentation based on the ARD and assessment type. If the clinical team provides documentation with knowledge of how it is used in the RAI process, it is less likely information will be missed. Also, to decrease the risk of provider liability due to missed assessments, leadership can include ARD selection in the admitting nurse’s duties. Finally, they can ensure there is a backup NAC who periodically completes assessments to keep skills up, so that if assistance is needed with MDS completion, a trained person is available to assist. Many organizations utilize floating NACs or temporary NAC agencies to assist with MDS completion. While these steps require advance preparation, they can mitigate the unintended consequences of diverting resources from the NAC role. By recognizing the vital nature of the role and enhancing the facility’s ability to fulfill NAC responsibilities, leaders can prevent something they intend as a solution from causing additional problems. <br><br><em>Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, is curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).</em></p>2022-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/SeptOct/PublishingImages/caregiving.jpg" style="BORDER&#58;0px solid;" />Workforce;CaregivingJennifer LaBayTemporarily shifting the NAC to an open spot may solve an immediate problem. It could also negatively affect reimbursement, quality outcomes, and the facility’s rating.
Survey: More Than Half of Assisted Living Providers Say Their Overall Workforce Situation Has Worsened<p>​Today, the National Center for Assisted Living (NCAL), representing more than 4,000 assisted living communities across the country, released a survey of assisted living providers highlighting how the industry is still facing a serious staffing and economic crisis.&#160;&#160;</p><p>Key findings include&#58;</p><ul><li><p>More than half (52 percent) of assisted living providers say their overall workforce situation has worsened since January 2022.&#160;</p></li><li><p>63 percent are experiencing staffing shortages. A quarter of those assisted living providers say they have a high level of staffing shortages.&#160;</p></li><li><p>93 percent have increased wages to help attract and retain caregivers.</p></li><li><p>98 percent have asked staff to work overtime or extra shifts due to the staffing shortages. Half have hired temporary agency staff due to shortages.&#160;</p></li><li><p>87 percent say they have difficulty hiring new staff.&#160;</p></li><li><p>The biggest obstacle for assisted living providers in hiring new staff is a lack of interested or qualified candidates, with two-thirds of providers saying it was an “extremely big” challenge.&#160;</p></li><li><p>Nearly half (48 percent) are concerned they may have to close their assisted living communities if workforce challenges persist.&#160;</p></li><li><p>On average, assisted living providers say their operational costs have increased since this time last year by 40 percent.&#160;</p></li><li><p>More than one-third are currently operating at a loss (37 percent) and can’t sustain current operating pace for more than one year (35 percent).&#160;</p></li></ul><p>Assisted living professionals will share these findings as well as their own unique, local perspectives with members of Congress during the association’s Congressional Briefing event, taking place Monday, June 6 and Tuesday, June 7. More than 500 long term and post-acute professionals are expected to visit the Hill, advocating for legislation and policies that will help address these workforce and economic crises.&#160;</p><p>“The survey shows that the workforce crisis in assisted living has not improved, and we are deeply concerned that more assisted living communities will have to close their doors,” said&#160;NCAL Executive Director LaShuan Bethea. “Assisted living has been largely forgotten by public health officials during this pandemic—it’s time they received the resources and the support they desperately need.”</p><p>View the assisted living provider survey results&#160;<a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/AL-Survey-June2022.pdf" target="_blank">HERE</a>. The survey also included other long term care providers, and the nursing home results may be found&#160;<a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/SNF-Survey-June2022.pdf" title="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/SNF-Survey-June2022.pdf" target="_blank">HERE</a>.<br></p><p style="text-align&#58;center;"><img src="/SiteCollectionImages/logos/ncal_large_color.jpg" alt="" style="margin&#58;5px;width&#58;250px;height&#58;167px;" /><br></p>2022-06-07T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/survey.jpg" style="BORDER&#58;0px solid;" />WorkforceAHCA/NCAL StaffSurvey of assisted living providers highlights how the industry is still facing a serious staffing and economic crisis.
Apprenticeships Are Lighting the Road to Retention<p style="text-align&#58;center;"><img src="/Monthly-Issue/2022/JuneJuly/PublishingImages/060722_apprentice_banner.jpg" alt="" style="margin&#58;5px;width&#58;742px;height&#58;200px;" /><br></p><p>In the midst of a national workforce crisis, finding effective ways to keep the good workers you have can feel like a heavy lift. But one way to take the weight off this challenge is to engage frontline team members in a certified nursing assistant (CNA) apprenticeship program. <br></p><p><img src="/Monthly-Issue/2022/JuneJuly/PublishingImages/ToddSchmiedeler.jpg" alt="Todd Schmiedeler" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;155px;height&#58;176px;" />“We know that residents are coming into our facilities with higher acuity and greater demands for customer service. An apprenticeship can help facilities address these challenges,” said Todd Schmiedeler, chief executive officer (CEO), Thumbprint Consulting, in Louisville, Ky. He added, “This creates an avenue where everyone gets in a pathway that helps them grow and become more self-sufficient. It’s about finding out where our CNAs want to go professionally and helping them get there.”</p><h3>RAP Taps into CNAs’ Potential and Passion to Learn</h3><p>A CNA registered apprenticeship program (RAP) is a career pathway where individuals obtain paid work experience and classroom instruction through a nationally recognized program. This takes them to a higher level of skills and enables them to obtain specialized training and certification. <br></p><p>Ideally, an apprenticeship not only raises skill levels but also productivity, efficiency, and leadership abilities, thus contributing to greater worker satisfaction and the quality of resident care. A key element of a good apprenticeship is clear wage and career progression. Most commonly, wage increases are tied to the completion of special occupational competencies or program modules. This opportunity to make more money, as well as take on new roles or responsibilities, serves as an incentive for participants. <br></p><p>Individuals who complete apprenticeships often go on to become mentors for new apprentices. Usually, these programs are provided at no cost to the worker, and many also cover related fees and materials. Some also offer a stipend to help participants with childcare or transportation expenses.<br></p><p>RAPs provide training in core competencies to equip participants with the knowledge and experience to serve effectively as a CNA. Additionally, programs may involve advanced competencies in specialty areas (such as palliative or end-of-life care) that apprentices will need for a specific care setting or type of facility. At the same time, RAPs also involve competency training in soft skills such as communicating with residents and staff, managing stressful situations, and leadership skills. <br></p><p>There are numerous national program sponsors and industry intermediary groups that offer RAPs. The key, suggested Schmiedeler, is finding one that has conducted apprenticeships for health care and understands the long term care setting. &#160;<br></p><p>One advantage of having an RAP is that you are eligible for funding to support the development and expansion of RAPs. For instance, the Department of Labor (DOL) recently announced the Apprenticeship Building America Grant Program, offering a total of $113 million to pay for worker apprenticeship programs. Grant applications were due on April 25, 2022, and awards notifications are pending. <br></p><p>LaShuan Bethea, NCAL executive director, and AHCA’s senior director of not-for-profit and constituent services Dana Ritchie are pleased to announce that AHCA/NCAL has entered into a partnership with a group called Equus Workforce Solutions for offering long term care apprenticeship programs for our state affiliates and/or provider members that are interested. Bethea and Ritchie noted that, “AHCA/NCAL is excited to be collaborating with Equus to support the development and expansion of RAPs that can positively impact our members and those they serve in the future. The partnership will help to encourage more to enter the long term care field.”<br></p><p>Michelle Day, National Workforce Solutions Director, is leading up this partnership for Equus and noted “Under contract with the DOL, Equus serves as an Industry Intermediary and National Apprenticeship Program Sponsor. Our team provides technical assistance to support the development and expansion of RAPs with a focus on the health care industry. As a comprehensive provider of workforce development services, Equus is uniquely positioned to connect career seekers to apprenticeship opportunities.”</p><h3>More Than a Flyer</h3><p>“We think sometimes that if we communicate something through a flyer, people know about it. But that’s not enough to help CNAs understand how an apprenticeship benefits them and their residents,” said Schmiedeler. <br></p><p>Sherry Perry, board chair of the National Association of Health Care Assistants (NAHCA) and a long-time CNA, agreed, “How the apprenticeship program is introduced makes a difference.” For instance, she suggested it’s important for CNAs to understand that while the apprenticeship is about career advancement and upskilling, it doesn’t mean they have to go back to school and/or become a nurse. An apprenticeship, she said, would be attractive for CNAs who love their jobs but would like to advance in this role and have more opportunities as part of the clinical team.<br></p><p>Perry stressed that the apprenticeship must result in real opportunities after CNAs complete it. “Everyone on the team needs to know what an apprenticeship is and what it means. CNAs who complete the program must feel that they are more respected and have new opportunities that they didn’t have before. <br></p><p>You can’t just do it for appearances.” Also remember, she noted, that other CNAs will be watching what happens. “They will be paying attention. They need to see the positive impact of the apprenticeship programs on CNAs who go through it. If they don’t see any impact or benefits, they won’t see it has a genuine attempt by the facility to invest in and lift up CNAs.”<br></p><p>Schmiedeler said, “Thought leadership is often underrated, but it can make a powerful difference.” If a CNA who is respected and looked up to by others goes through the program and can say it makes a difference, more are likely to embrace it. He explained, “Their energy translates to other people.” At the same time, he said, “You need to look beyond general communication. Everyone’s invitation is no one’s invitation if it doesn’t make you feel special.”<br></p><p>Establish the criteria for participation up front, Perry suggested, adding, “Be transparent about who is eligible, what will be expected of them, and what they will get from the program. Start with your long-term people, those who stood by you during challenging times. Don’t just start with new people and forget your veterans.”</p><h3>The RAP in Action</h3><p><img src="/Monthly-Issue/2022/JuneJuly/PublishingImages/TinaSandri2.jpg" alt="Tina Sandri" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;155px;height&#58;177px;" />The RAP is an important career ladder that gives CNAs an opportunity to climb to heights they didn’t have access to before. As Tina Sandri, CEO of Forest Hills of Washington, D.C., said of her organization’s program, “We are trying to career-ladder our CNAs to be leaders and connect them with the necessary educational resources.” She added, “Sometimes in life it’s not easy getting to that next step, and we need a nudge. This is a nudge to get our CNAs to the next rung of education if they so desire.”<br></p><p>Forest Hills partnered with Suma Prime School of Healthcare, in collaboration with the D.C. Department of Employment Services, to build an apprentice program. In addition to receiving an industry-recognized credential that meets both D.C. and national standards, graduates also will receive encouragement, support, and connections to resources to further their education and pursue Licensed Practical Nurse (LPN) and Registered Nurse (RN) careers. Forest Hills received grant funds from D.C. Healthcare Career Advancement Program to jumpstart the program. Sandri said, “About 70 percent of the program is online, and the rest is onsite. The focus is on retention.” <br></p><p>Sandri so believes in the apprenticeship program and the importance of investing in CNAs that she and her organization recently applied for an Apprenticeship Building America grant to build an apprentice program that every nursing home in D.C. can take advantage of and to build training programs around the city. They also have applied for an AARP grant aimed at fostering resiliency within the workforce. <br></p><p>“Resiliency is low hanging fruit in terms of getting staff to stay. People are committed but tired, and we are trying to find ways to boost their resilience and keep them from burning out.” In addition to the incremental pay bumps, she suggested, there are other ways facilities can encourage and incentivize CNAs to participate in and complete apprenticeships, such as offering scholarships. <br></p><p>Sandri admits that launching an apprenticeship program can be challenging. With budgets tight, it’s not always easy to find money for such endeavors. She said, “That is why we are chasing grants. But if you watch your tips and insights from AHCA, stay alert for various funding opportunities, and are prepared to roll up your sleeves, it can be done.” <br></p><p>Is it worth it? Sandri thinks so. She said, “The principle of encouraging the best and brightest is basic. How can you afford not to? We hear from our staff that pizza parties and other efforts are nice but that we need to do more. We need solutions that make people feel heard, appreciated, and valued on a deeper, more sustained level.” She further noted, “The biggest metric we are going after is decreased turnover rate. The apprenticeship is a promising strategy. When we have such programs designed to support, engage, and empower our teams, outcomes are better. While there isn’t enough data to link this directly to apprenticeships, we do know that low turnover yields better results, and these programs can help us do that.” ​</p>2022-06-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/JuneJuly/PublishingImages/060722_apprenticeship.jpg" style="BORDER&#58;0px solid;" />WorkforceJoanne KaldyIn the midst of a national workforce crisis, finding effective ways to keep the good workers you have can feel like a heavy lift.
A Small World is a Big Solution for Workforce Woes<p style="text-align&#58;center;"><img src="/Monthly-Issue/2022/JuneJuly/PublishingImages/060722_immigration_banner.jpg" alt="" style="margin&#58;5px;" />&#160;</p><p style="text-align&#58;center;"><br></p><p>Sometimes we find ideas in our own backyard. Other times they come across the ocean or halfway around the world. Increasingly, post-acute and long term care leaders are finding physicians, nurses, frontline workers, and other staff in numerous countries. While immigration isn’t a panacea, it’s one promising solution to the workforce shortage. <br></p><p>Over several years, Jody Knox, chief executive officer of Lakeview Christian Home, Carlsbad, N.M., and her team have brought in nurses from nine different countries, most from the Philippines. “They are all RN-trained and have brought stability to our workforce. They are kind and caring and have made us a better community; they’ve become like family,” said Knox. <br></p><p>Access to these nurses always had a positive impact, but even more so when COVID hit. “During the pandemic, we didn’t have to bring in traveling nurses, but we struggled horribly with frontline staffing shortages. We decided to have some nurses handle care such as bathing and feeding.” That may sound like an expensive use of nursing staff, she said, but it would be more expensive to use agency certified nursing assistants (CNAs). Knox added, “We’re not sure how this will work down the road. But it has changed who we are.” She added, “Having bachelor-prepared nurses is a big deal. They provide quality skilled care.”<br></p><p>There definitely has been an increased interest in international staffing in the health care sector, particularly for registered nurses, partially due to the increasing need for nurses and a more long-term strategy of employers. Sherry Neal, an employment-based immigration attorney in Cincinnati, Ohio, says, “We have seen the ebb and flow of international nursing throughout the past two decades, but the demand has significantly increased since the pandemic. The nursing need is serious, and health care organizations know it’s not getting better any time soon. A decade ago, some hospitals and health care organizations shied away from international hiring because of the 12- to 18-month processing time for an immigrant visa. Now more and more organizations are realizing that although international hiring is not a quick fix; it’s part of the long-term strategy to help alleviate the shortage.” </p><h3>American Adjustment</h3><p>There needs to be a balance between giving immigrants the means and opportunities to celebrate their native cultures and helping them understand American ways of working and living. For instance, Knox said, “We have to teach them about American medicine and how we look at things like death and dying. This is different from what is believed in some countries.”<br></p><p>Providing help to get new workers acclimated is essential. This means efforts such as helping them find and retain affordable housing and transportation, arranging for cell phones, and securing services such as childcare. <br></p><p>Language barriers may exist, but this is typically not a problem for international registered nurses. Neal says, “As part of the immigration process for a registered nurse to obtain a green card to work in the U.S., a nurse has to pass an English proficiency exam as well as other credentialing requirements.” Usually, for instance, the only language adjustment for Filipino nurses is becoming familiar with American slang. </p><h3>All Together Now</h3><p>From the early days of this country, immigrants were sometimes demonized and ostracized instead of celebrated. So it is essential to help staff embrace their immigrant colleagues. The ease of this may be surprising. As Knox said, “We are a rural facility and have a large Hispanic population. We have long experienced people speaking multiple languages. At the same time, we try to teach people to be respectful and mindful.” She added, “We have nine different languages being spoken here, but we teach people to be courteous to others, for example, by not speaking another language in front of residents or staff who don’t understand it.”</p><h3>Policies that Promote Immigration</h3><p>American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and other organizations are working to help ensure that organizations that want to bring in practitioners and workers from other countries have that opportunity. The processing of immigrant visa applications has been backlogged due to the pandemic and reduced staffing at U.S. embassies and consulates. Many international health care professionals with job offers from long term care facilities in the U.S. with approved immigrant petitions have been waiting a year or longer for visa interview appointments. Neal says, “There has been progress the last six months as consulate appointments have begun to increase, yet processing times have always been slower than desired. Even before the pandemic, employers had to expect a typical processing time of at least a year.” <br></p><p>Dana Ritchie, senior director of not-for-profit and constituent services at AHCA/NCAL, said, “We are pleased about the recent announcement from the U.S. Immigration and Citizenship Services regarding new actions to reduce the significant legal immigration backlogs and encourage further actions along these lines. We also have been working closely with national refugee organizations, noting our center doors are open to those new to our country who would like to pursue a career in long term care.” She stressed, “AHCA/NCAL strongly supports immigration reform.”<br></p><p>Elsewhere, Rajeev Kumar, MD, CMD, FACP, chief medical officer for Symbria in Warrenville, Ill., recently drafted two resolutions regarding immigration that passed the AMDA—The Society for Post-Acute and Long-Term Care Medicine House of Delegates in March 2022. He said, “These resolutions stemmed from a conversation our board had about struggling with the workforce issue. I also thought about my experiences when I first came to this country and did my training.” <br></p><p>In short, the resolutions are&#58;<br></p><ul><li>Undocumented Noncitizens for Post-Acute and Long Term Care (PALTC). This calls for AMDA and like-minded organizations to advocate for legislative action to create a pathway to immigration for undocumented noncitizens in the U.S. who show their commitment to their intended homeland by working as Certified Nursing Assistants and/or nurses in PALTC settings for a minimum of five years.</li></ul><ul><li>Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) Designations for PALTC. This calls for AMDA and like-minded organizations to advocate for designation of all PALTC communities, irrespective of their geographic location, as HPSAs and/or MUAs to facilitate professional recruitment/retention.<br></li></ul><h3>It’s Complicated</h3><p>No doubt, immigration is complicated. Positions like professional nurses and physical therapists are U.S. Department of Labor Schedule A workers. This means that employers don’t need to get a foreign labor certificate when hiring these individuals. Instead, you must agree to sponsor the employee for permanent residence in the U.S. Schedule A nurse recruitment can be effective for helping to address nurse shortages. However, there are limitations and barriers. For instance, depending on the country of origin, it may take a year or more to process the petition.<br></p><p>Elsewhere, the TN Visa—for Mexican and Canadian Citizens—is a nonimmigrant visa, which is for temporary employment. However, it can be extended in three-year increments. <br></p><p>The most common temporary visa option in professional occupations is the H-1B. However, although registered nurses are “professionals,” they rarely meet the standard for H-1B. The H-1B is reserved only for occupations that require a bachelor’s degree. Even if a nurse has a bachelor’s degree, that’s not sufficient as the position/occupation itself must require a bachelor’s degree. Since most registered nurse positions in the U.S. can be filled by a nurse with an associate degree or diploma, it’s hard to overcome the U.S. </p><p>Citizenship and Immigration Service perception that registered nursing is not a specialty occupation for H-1B, unless the employer can show the nurse is filling a more specialized or complex nursing role where the employer does require its other nurses in that area to have at least a bachelor’s degree. <br></p><p>A pitfall, said Steve Flatt, chief executive officer of National HealthCare Corporation in Murfreesboro, Tenn., is that “this is a very slow process, and it’s tedious, especially the interview process at the embassy level. I’m hoping that the process will pick up speed, but right now it is slow and cumbersome.” However, facilities don’t have to go it alone or start from scratch. Flatt said, “It’s helpful to engage a third party that focuses on bringing international workers to the U.S. They’re adept at completing the paperwork and following through the process. They also know how to clear the hurdles that can make it cumbersome.” </p><p>He noted that this can cost money, and providers need to be prepared for that. He added that while bringing nurses from other countries can be pricey, it can be “a bargain” compared to the costs of hiring agency nurses. He said, “You get full-time staff who will be with you day-in and day-out and provide continuity of care, which always leads to better quality.” <br></p><p>Moving forward, immigration will likely continue to play a significant role in addressing long term care workforce shortages. President Biden has announced a commitment for the U.S. to take in 100,00 Ukrainian refugees, and AHCA/NCAL is already working with facilities across the country to offer thousands of jobs for these individuals. Of course, many will not have the ready credentials to work in some health care occupations, but some may be able to obtain the additional training or education in a fairly short time or can fill other positions within the sector. Participating facilities will also offer refugees training, relocation assistance, and support for their integration into local communities. Flatt said, “This is not the cure-all to our workforce issues, but it should be considered a major part of solving this challenge for the foreseeable future.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.​</em></p>2022-06-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/JuneJuly/PublishingImages/060722_immigration.jpg" style="BORDER&#58;0px solid;" />Workforce;COVID-19Joanne KaldyIncreasingly, post-acute and long term care leaders are finding physicians, nurses, frontline workers, and other staff in numerous countries. While immigration isn’t a panacea, it’s one promising solution to the workforce shortage.