One in five registered nurse positions in hospital-owned nursing homes are vacant, a new study by the Maine Hospital Association has found.

The shortage is up 71 percent from a year ago and it is twice as acute as the nursing shortage within hospitals themselves, the study reports.

“I think this tells a statewide story because our hospital-owned nursing homes are spread out across the state,” said Kevin Lewis, MHA’s director of continuing care who wrote the report. “It just points to the gravity of the problem.”

The shortage results in longer waits for people at home or in the hospital who need to get into a nursing home for rehabilitation or long-term care, Lewis said. Fifteen percent of those surveyed reported having developed waiting lists for admissions, and 55 percent said the shortage caused more paperwork for direct care providers.

Hospital-owned nursing homes account for one out of five nursing homes in the state. The study, which included 20 of 28 hospital-owned nursing homes, also found:

. 13 percent of certified nursing assistant positions [CNAs] are unfilled – nearly twice as many as last year.

. Half of long-term care registered nurses are 50 or older.

. One-third of administrators surveyed said they had to resort to expensive, temporary staffing agencies. In 2000, the use of nursing home temporary workers in Maine was double that of the nation.

The problem in getting help is that workers aren’t paid well relative to many other available jobs, said Lewis.

Nurses in nursing homes make less than hospital nurses because of low reimbursements from Medicaid, which pays for many residents. Nursing home nurses made $17 an hour on average in 1998, while all registered nurses made $18.59, according to state figures.

Brenda Gallant, executive director of Maine’s Long Term Care Ombudsman program, a patient advocacy group, explains that the work is often hard.

“You’re taking care of people who may have dementia … and it takes skill to do that,” she said. How do you keep CNA’s and some other workers “who can go someplace like a Burger King and make the same amount of money?” she asked.

Gallant thinks society doesn’t put enough value on caring for the elderly.

“We also have to honor the work that’s done,” Gallant said. “I don’t think we do that enough.”

Lewis said part of the shortage is directly attributable to inadequate Medicaid funding. In 1999, Medicaid reimbursement was $9.3 million below costs across the state, he said.

Medicaid isn’t keeping up with inflation, which makes it very difficult to keep long term facilities in the black, said Roy Hitchings, CEO of Penobscot Bay Medical Center, in Rockport, which owns two nursing homes. He is also chairman of MHA’s continuing care council. He said the amount of time long-term care workers spend on paperwork is now half an hour for every hour of care.

“I think that’s a ridiculous ratio,” he said.

As shortages mount, the pressure on facilities to turn to temporary staffing, or “travelers,” grows. This is expensive, costing more than double what a regular staffer may make, and it pushes expenses over federal caps, thereby reducing reimbursements further.

“The contract labor problem is a huge problem,” said Brenda Gallant, executive director of Maine’s Long Term Care Ombudsman program, a patient advocacy organization.

Gallant said not only are the replacement workers expensive, they also don’t know the patients they must suddenly care for.

“When you bring somebody in who has no knowledge of residents, it’s very difficult,” Gallant said.

Gallant noted that the shortage of workers for home health care is also particularly steep.

While MHA continues to lobby for legislative action on Medicaid rates, some hospitals are taking other steps.

Hitchings said Pen Bay has created a unique training arrangement with Midcoast Adult and Community Education.

Applicants to the CNA program are interviewed by educators and by Pen Bay simultaneously. For those deemed qualified, Pen Bay offers to pay their tuition and wages as they take the program. When they graduate, they get a sign-on bonus and are employed at a starting wage of $8.45 an hour.

Each class provides about six to 10 people and the third class is now under way, Hitchings said.

“We get excellent results,” Hitchings said.