OHA Director Floats $33.5 Million Plan To Bolster State Hospital Hiring

Oregon State Hospital 10.20.21 Ben Botkin .jpg

Large red building, the Oregon State Hospital

Oregon Health Authority leaders are requesting $33.5 million to boost Oregon State Hospital staffing by 359 employees.

The 11-page request, obtained by The Lund Report, lays out ambitious goals for bolstering Oregon State Hospital’s workforce, which is plagued with staffing shortages, overworked employees and concerns about safety. 

The hiring would begin in March 2022 and include 283 nurses, therapists and mental health therapy technicians, according to a Nov. 1 memo sent by OHA Director Patrick Allen to the Interim Joint Committee on Ways and Means, which oversees the budget.

The state-run residential psychiatric facility has struggled to maintain its footing amid the pandemic as the crisis has mounted. The state hospital is headquartered in Salem and has a smaller campus in Junction City. 

The letter represents a potential long-term path forward if state lawmakers fund the request. Lawmakers will gather next week to hear updates about issues and the revenue forecast in advance of the February short session.

The request was submitted in response to lawmakers’ direction earlier this year to come up with a staffing plan that ensures “the safety of both patients and staff.” And it comes amid challenges on multiple fronts:

  • The hospital has struggled to process “aid-and-assist” patients who need to recover enough to assist in the defense of criminal charges they face. The hospital is required to admit those patients within seven days and faced a federal lawsuit over its sluggish admissions of those patients who languished in county jails waiting for hospital admission.
  • Disability Rights Oregon, a federally-certified watchdog organization, sent a letter to the health authority in October based on staff interviews. It cited dire concerns about the lack of adequate treatment for patients and a system in chaos. 
  • The hospital’s advisory committee also has weighed in with concerns about patient care and employees.

Allen’s memo, crafted with input from labor unions, employees and managers, acknowledges the hospital’s struggles.

“The COVID-19 pandemic has significantly affected OSH, like many of its healthcare counterparts, over the last two years,” Allen wrote. “The current shortage of healthcare workers is of significant concern. As a state-operated psychiatric facility, OSH is not as nimble as organizations it competes with for workers.”

‘Adequate Staffing Level’

Oregon State Hospital usually has around 500 patients at any given day. State lawmakers have budgeted more than 2,200 positions for the hospital in the 2021 session.

If approved, Allen wrote, the requests in the plan would allow the hospital to address “shifting population needs and have an adequate staffing level.”

Here’s a detailed look at the request:

  • In its entirety, the request seeks the authority to add 493 permanent positions to its workforce.This includes 359 new positions that need funding and converting another 134 unbudgeted positions into permanent positions.  The hospital already has money for the 134 positions. Legislative authority is usually necessary for an agency to add permanent positions, though agencies have the flexibility to hire temporary staff to deal with unexpected needs and emergencies.
  • Of the 359 new positions, 283 of them would be nursing staff. That includes 31 licensed practical nurses, five nurse managers, 51 mental health registered nurses, 133 mental health therapy technicians and 63 mental health therapists.
  • The remaining 76 positions requested would go to various departments, including safety and security, clinical and other support roles. This also includes new staff to help with the human resources task of onboarding and training hundreds of new employees, the memo said.
  • Hiring for the new positions would stretch into 2023.The proposed phased-in approach would hire 209 employees in March 2022, 105 employees in October 2022 and 45 employees in April 2023.
  • The $33.5 million represents the cost of the positions for the remainder of the 2021-2023 budget cycle, while the cost of the positions for the entire 2023-2025 budget cycle is estimated at $63.2 million.

“I am glad to know what their north star is and I am committed to making the state hospital work better for patients and staff,” said Rep. Rob Nosse, D-Portland and co-chair of the Subcommittee on Human Services, part of the Legislature’s joint budget committee. “It is vital to get the staffing at the state hospital right if we are going to make behavioral health care better and more accessible in our state.”

Other Requests 

To come up with its staffing proposal, the state hospital took input in a variety of ways. One group, called the staffing solutions workgroup, had six labor union representatives and four managers and met from for several months to address root causes of the staffing challenges and craft a proposal. The hospital also consulted with clinical and operations managers to build a plan. 

The workgroup recommended other changes beyond simply adding more people. 

For example, it wants to offer state pension benefits to hospital employees that are comparable to what police officers and firefighters receive. Those pensions are generally more generous and allow earlier retirements due to the strenuous nature of the work. The workgroup determined that because the hospital is a “secure institution” and has a large and growing population tied to the criminal justice system, its employees should be eligible for the increased pension, Allen said.

At this point, Allen said, he doesn’t have a price for the recommendation, which would require input from other agencies.

For Oregon State Hospital employees, pay can be similar to what fast-food workers earn. Mental health therapists earn a starting wage of $16.45 an hour. Allen, in his memo, said those wages are “among the lowest in the state.” He’s requesting a salary study to ensure competitive wages for the group.

Another recommendation calls for putting nurses on a 36-hour workweek with three 12-hour shifts. Currently, nurses work 40-hour weeks and overtime. The move “would allow OSH to be comparable and competitive in hiring with other hospitals,” Allen wrote.

This could add efficiencies and savings, OHA contends. For example, the hospital would only need two registered nurses to cover a unit during one 24-hour period. Each one would work a 12-hour shift. However, under the current system, three nurses are needed, each one working an eight-hour shift, Allen wrote.

The final details and savings details would be contingent on the outcome of bargaining with labor contracts.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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