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Worker shortage causes long waits for child psychiatric care

Doctor shortage 110819
Posted at 9:49 AM, Jun 14, 2021
and last updated 2021-06-14 10:49:05-04

TOPEKA, Kan. — Psychiatric facilities have enough beds to treat children in Kansas in need of intensive mental health care, but a worker shortage means that about 100 of those spots remain empty.

Kansas News Service reports that in recent years, children have often waited months for openings in specialized facilities that offer long-term psychiatric care. In mid-2018, the average wait was nearly 200 days.

The wait time fell in 2019 and 2020, and as of last month, the average wait was 44 days. Yet 146 children remain in line for their turn, even though 104 beds are open.

Residential care centers are struggling to fill jobs that are physically and emotionally taxing, yet sometimes pay less than $15 an hour.

KidsTLC in Olathe is urging the state to help with incentives that could range from college tuition waivers and signing bonuses to subsidies for health insurance or child care.

KidsTLC bought land in March 2020 to add another 50 beds for children, and that work was finished in December, nearly doubling KidsTLC's residential capacity. Forty-five of the new beds remain empty.

"We had space, we were licensed, and were feeling just exceptional about that and being able to make a significant dent in that waitlist," CEO Erin Dugan said. "And then it became really hard to hire staff."

Nonprofit facilities offer more than 400 beds for long-term psychiatric youth care in Kansas. Many of those slots were added within the past 18 months as the administration of Gov. Laura Kelly worked to license more beds and reduce wait times.

Andrew Brown, the state's commissioner of behavioral health services, said the state would like to get to a point where the average wait time is a week or less.

KidsTLC has almost 300 workers but wants about 425. It has not struggled to hire and retain therapists and other salaried specialists. But hourly staff trained to work on site around the clock are a different matter.

Dugan said her organization offers starting pay of $14 an hour. It is now considering raising that to $16 an hour, but doing so would require significant fundraising by KidsTLC, which gets paid for its patients by Medicaid. Medicaid rates are widely considered low compared to private health insurance.

"How does KidsTLC find a couple million dollars?" Dugan asked. "It's not sitting around."

Meanwhile, the state has called on one of its Medicaid contractors to reduce wait times.

KanCare, the state's Medicaid system, is privatized and run by three companies: Aetna Better Health of Kansas, Sunflower or UnitedHealthcare.

Those companies review and approve applications for residential treatment, but the state's tracking of wait times that began in 2019 found that children with Aetna waited significantly longer than the others. The state found that Aetna appeared to have problems promptly gathering paperwork such as parental releases to get children in line for care.

"We hope that we will see improvements," Brown said.

Aetna said it took swift action after the state pointed out the problem.

"We immediately took steps to review our process, identify causes for delays, and implement the changes necessary to minimize interruptions in care for our members," a company statement said. "As a result of our internal review we have modified our processes to eliminate avoidable delays."