What Happens When the Health-Care Helpers Are Gone in Aging Farmlands?

“When I was a boy and I would see scary things in the news my mother would say to me, ‘Look for the helpers, you will always find people who are helping.’” —Fred Rogers

I am an EMS worker in Gove County, Kansas, an Aging Farmland in the American Communities Project. Here in aging rural America, where we’re barely able to keep our heads above water, we are losing our health-care helpers every day. And many of the faces of the helpers we do have don’t look familiar to us anymore. There is a “bait and switch” happening in health-care staffing, as corporate agency nursing companies are luring in our most valuable resources, our people, by paying them wages two to five times higher than our rural hospitals are able to, skewing the pay scale across the board. This is hitting us hard in very rural northwest Kansas now.

Contract nursing agencies are recruiting our local staff away for higher pay, and sending them to hospitals 40-90 miles away. Conversely, they recruit staff from the same distance away and send them to us through their services, with hourly contract pricing hitting the local hospital at four to eight times the expense of a standard wage paid. Some of our local health-care workers need the increased income because of Covid, bills, large student debt, etc. We can’t fault workers, but we have every right to be frustrated at the growing predatory market. The shift is really sticking it to the rural hospitals, kicking us while we are down.

Dusty, a registered nurse who started as a Certified Nurse Aid in our community years ago, has recently left for higher wages. We picked up a patient on EMS recently, and this patient asked me in the ambulance: “Will Dusty be working tonight? He is my favorite nurse,” In the ER, the patient again asked: “Is Dusty working tonight?” Dusty is a good nurse, who’s good to his patients and to us on EMS. No one can fault anyone for wanting better for their family, but there is a comfort factor when a patient knows their caregiver. Knowing the patient history, family dynamics, preferences, etc. helps patients and nurses tremendously. Dusty still works a shift or two every month here locally, but his presence is missed. Dusty isn’t the only one; the faces in the hallway aren’t familiar — they are 100% skilled staff , but the patients don’t know them.

I worry the aggressive market share capture by the large agencies will be more than we can afford in rural America, and it will affect patient care and outcomes. We need to bring attention to this matter. Our legislators need to hear our worry. Rural hospitals are being held hostage.

We are watching a record number of health-care workers (including support staff) exit the field altogether. This shortage in a region bleeding our greatest resource, our amazing people, is laying out a perfect predatory map for corporate placement agencies to gobble up the rural market altogether. There absolutely is a place for agency nursing. If someone wants to deepen their expertise by gaining experience in ICU / Infusion / Cardiac / Pediatrics / ER, the likely route is joining an agency team.

However, these agencies are now gobbling up the rural market, forcing small hospitals to pay outrageous hourly contract rates for staff providing the same care in a different hospital. The bait: recruiting primary care, critical access workers, offering them double to triple their hourly wage if they “join the staffing team.” The switch: placing them into a different hospital 40 to 90 miles away providing the same care, while charging the hospital exorbitant contract fees.

The result of this bait and switch: loss of continuity of care for the patient, tremendous new employee training expenses for the hospitals, very high turnover, and ultimately low morale. Can you imagine being a hospital employee for 15 or 20 years and having to provide orientation to an agency staff member who is making $8 to $15 more an hour than you are? In addition, these small rural hospitals are mostly county-funded, and taxpayers are frustrated because they can’t understand how their county hospitals can’t make it on the subsidies that they shoulder for them.

Hospitals must have staff to operate, so they are forced to pay for contracts that cost exponentially more since Covid started. It is supply and demand, really: When you are short on something, typically you pay more. But the cost is simply too high, and it’s hurting us more than just in dollars and cents.

One of the best things I experience on EMS is a patient recognizing our faces when we are sent to help them. A sense of comfort comes over them when they can call us by name. While providing care to them, we often grasp hands in the back of an ambulance, we sing, we laugh, we cry, and we pray together. The same things happen in hospital rooms. Historically, we have had the luxury of knowing our hospital staff. They have been there when our babies were born, and we celebrated with them. They have also been there to hold us up and wipe our tears when our grandparents or parents leave their physical bodies behind and enter heaven.

While the world digests Covid statistics and debates masks and vaccines, the business of health care pushes on. Our staff, with a focus on patient care, forges ahead, despite all the noise around them. They are the very best among us — from the Covid screener at the front door, to the billing office, to food and environmental services, to direct patient caregivers: They are the helpers.

The backs of rural hospitals are against the wall, but don’t count them out. The market is creating space to help rural health care evolve … if these hospitals can make it through the financial bottleneck created by agency nursing. You will not receive better primary care than you will in these little hospitals by the people you know. I promise.

Ericka Nicholson was born and raised in Gove County, Kansas. Nicholson runs the local ambulance service, spent years lobbying for rural Kansas, owns a local business, and is heavily invested in rural America.