CDHS responds to direct care staffing shortage, regulatory finding

DENVER (June 9, 2017) — The Centers for Medicare and Medicaid Services (CMS) has issued a finding of “immediate jeopardy” to the Colorado Mental Health Institute at Pueblo (CMHIP), citing staffing levels that the federal agency believes negatively impacted patients. CMHIP announced a plan that centers on patient care and is intended to boost staffing levels at the state-run, inpatient psychiatric hospital.

CMHIP’s plan of correction was accepted by the regulators. If the steps are not completed to CMS’s satisfaction by June 28, the federal agency will terminate CMHIP’s Medicare provider agreement. CMHIP has been grappling for some time with serious staffing shortages. This includes an inability to always staff patients on a 1:1 basis when required, and not always having the minimum number of staff necessary to cover all shifts and run group therapy sessions.

“High quality patient care is our top priority. We take staffing levels at our mental health institutes very, very seriously,” said Dr. Kim Nordstrom, director of mental health institutes and medical director for the Colorado Department of Human Services’ Office of Behavioral Health, which oversees CMHIP. “There are many variables at work in the staffing shortage. The plan we have put in place will address the challenges identified by CMS. We are very grateful to our dedicated staff and we have all hands on deck.”

Along with vigorous efforts to address staffing challenges, the state Department of Human Services is conducting a comprehensive review of operations and practices at the 449-bed hospital. CMHIP’s plan includes temporary measures to immediately increase staff coverage, including mandatory overtime, revisions to work schedules, expedited hiring practices and freezing new annual leave requests, all of which will be done using existing funds and in accordance with personnel rules. It also includes longer-term efforts to attract and retain qualified staff and modify staff schedules.

The facility has no plans at this time to halt new admissions, but has temporarily closed a program (CIRCLE program) for people with co-occurring mental health and substance abuse disorders. Ten patients currently in that program are being transferred to appropriate alternative providers and the staff members assigned to that program will work in other areas of the hospital, where they will provide care for all patients, including those with co-occurring disorders who are not part of the CIRCLE program. 

In 2014, the U.S. Department of Health and Human Services predicted that Colorado would experience a shortage of about 17,000 registered and licensed practical nurses by 2025. Pueblo is particularly susceptible to the nursing shortage due to a limited pool of candidates and the demand created by two large, state-run healthcare facilities in the region and two other hospitals. CMHIP has been working to address the shortage through a number of proactive measures, including reducing the length of time from interview to hire, partnering with Pueblo Community College to provide jobs for recent nursing graduates, advertising in movie theaters and on radio, and engaging in hiring events in which potential employees complete their applications, interviews and screenings in a single day. In addition, the hospital offers sign-on and referral bonuses. CMHIP also has multiple ongoing efforts aimed at retention of current staff, including a mentorship program and employee appreciation events and is analyzing options for making nurse compensation more competitive.

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