Expiring COVID-19 waivers could make Pa. health-care staffing shortages worse

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One waiver expanded who could administer a vaccine dose. Fred Adams / For Spotlight PA

HARRISBURG — Regulatory waivers established last year to help hospitals and health-care workers fight COVID-19 will expire this month, and those in the field are warning the lapse could exacerbate an ongoing staffing crisis as coronavirus cases rise again.

At the beginning of the pandemic, Democratic Gov. Tom Wolf approved nearly 100 waivers to ease some of the rules governing health-care workers and ensure as many professionals as possible were on the ground in hospitals, vaccination clinics, and long-term care facilities.

They included allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who could give a vaccine.

The temporary changes were made under a disaster declaration that later became a target for legislative Republicans unhappy with the administration’s business closures.

Buoyed by two successful constitutional amendments that curtailed the executive’s power, the GOP-controlled General Assembly ended Wolf’s emergency order in June, while allowing the waivers to remain in place until Sept. 30.

The legislature will reconvene this month, and leadership in the House and Senate have said lawmakers will consider whether some waivers should be made permanent.

But as coronavirus infections continue to spike among the unvaccinated, those in the health-care field worry that even a temporary lapse of the loosened rules they’ve come to rely on for the last year and a half will only prolong the pandemic they’ve fought to overcome.

“To lose those waivers we’ve relied on as another surge is coming, as new variants are coming to long-term care, that would create a real challenge across the state,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which lobbies on behalf of long-term care facilities in the state. “We need those waivers until we can get out of this.”

It’s impossible to know how many people took advantage of the waivers, as the Department of State — which oversees professional licensing in Pennsylvania — did not track that information. Agency spokesperson Ellen Lyon said the waivers aimed to mobilize a larger workforce against the COVID-19 pandemic without creating new document-filing requirements.

But more than half a dozen health-care workers and industry advocates told Spotlight PA some of the relaxed regulations helped ease staffing shortages and deliver care during the pandemic.

Betsy Snook, a nurse and CEO of the Pennsylvania State Nurses Association, said online continuing education courses have provided flexibility for nurses who need the credits to stay licensed.

She also pointed to a waiver allowing nurse practitioners to see patients and collaborate with multiple doctors within the same hospital system without needing additional written agreements, which she said expanded the care those nurses can provide. Snook said she worries the nursing board that approves the agreements will be overwhelmed once the waiver disappears.

State licensing boards, industry groups, and Department of State staff last year asked the Wolf administration to consider waiving some requirements and regulations that were either no longer possible to comply with due to the pandemic or hindering pandemic response, according to Lyon. The administration ultimately relaxed rules that govern dozens of workplaces, including barbershops, salons, dentist offices, and funeral homes.

Some of those industries have returned to a semblance of normalcy, advocates said, so the waivers in place over the past 18 months are no longer needed. The same cannot be said for hospitals and long-term care facilities, where professionals said staffing shortages that existed before the pandemic have become much worse.

“Caring for people is really tough work, physically and emotionally,” said Georgia Goodman, director of government affairs for LeadingAge PA, a group that lobbies on behalf of nonprofit long-term care facilities. “A lot of staff we had left the field altogether, some had some early exits. It’s an awful storm.”

Michelle Boyle, a Pittsburgh-area nurse and former state Senate candidate, said in her decades in the field, she’s never seen nurses look so hollowed out.

“If you hollow something out, it’s just going to collapse,” she said.

Boyle, who is a member of SEIU Healthcare Pennsylvania, said allowing nurses to delay obtaining continuing education credits was helpful, as health-care workers were already “over their hours on a regular basis.”

But, she argued, the legislature needs to make meaningful changes that will make patients and the people charged with caring for them safer in order to retain staff.

Staffing shortages in the health-care field are a national problem, with difficult working conditions, burnout, and a highly competitive marketplace fueling the issue.

“If you look at almost any hospital in Pennsylvania, there are many, many, many job openings for these positions,” said Warren Kampf, senior vice president of the Hospital and Healthsystem Association of Pennsylvania. “Hospitals are paying retention bonuses, paying bonuses to sign, and they can’t fill them.”

COVID-19 infection rates have been rising nationwide, and though Pennsylvania has one of the nation’s lowest per-capita case rates, infections here are creeping up, as well.

Pennsylvania recorded more than 4,500 new coronavirus cases Friday, a daily tally not seen since the spring. Hospitalizations are on the rise, as well, with 1,926 patients in beds Friday and 236 on ventilators.

Patients who have been deferring care are returning to hospitals, flu season is starting, and emergency rooms are filling up with patients as public activity resumes, Kampf said. Staffing has been difficult even with the waivers.

“With nurses, physicians, [physician assistants], everyone in the hospital working like crazy under intense pressure, there are a lot of shortages out there,” he said. “You put all that together and it’s very tough to operate.”

When lawmakers return to Harrisburg this month, health-care advocates are hopeful there will be quick action to make some of the waivers, including one that permits doctors to use telemedicine, permanent. The state House committee on Aging and Older Adult Services will hold a hearing Monday to discuss how the lapsed waivers affect older Pennsylvanians.

But above all, those who spoke with Spotlight PA said permanent solutions are needed to ensure nurses, doctors, and front-line health-care workers can stay in their positions.

“The nursing shortage is probably the most important thing,” Snook said. “No matter how many beds we have, if we don’t have nurses, patients will die.”

(By Danielle Ohl of Spotlight PA)

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