Announcer:

The following program is a PBS Wisconsin original production.

Frederica Freyberg:

Baby boomers are leaving vacancies in critical healthcare roles, like EMS, nursing, and aides. Services that, as boomers age, will require more of, leading systems to a breaking point.

I’m Frederica Freyberg. Tonight on “Here & Now,” how staffing shortages impact the daily lives of nursing home residents. The Wisconsin Hospital Association speaks to the growing gap of care. Steven Potter reports on the state EMS system reaching its breaking point, and researcher Mike Wagner on political divides creating social divides. It’s “Here & Now” for April 14.

Announcer:

Funding for “Here & Now” is provided by the Focus Fund for Journalism and Friends of PBS Wisconsin.

Frederica Freyberg:

Wisconsin lost 42 skilled nursing facilities from 2016 to 2021, a reality seen nationally due to a shortage of nurses, certified nursing assistants or CNAs, and other staff. A new report from the Wisconsin Hospital Association shows CNAs have the highest turnover in the healthcare workforce, all of which has meaningful impacts on the people they serve. Marisa Wojcik has one couple’s story of their care. We are not naming the facility.

Lanea:

We’re so short staffed.

Dick:

Yeah, very short staffed.

Marisa Wojcik:

Dick and Lanea have been in the same assisted living facility for the last seven years. Since then, the facility’s ownership has changed hands multiple times, and the staff, many more times over. We first spoke with them in October 2021.

Lanea:

I have spinocerebellar ataxia, which — ataxia means uncoordinated, and, you know, it goes into all your nerves. But I couldn’t get out of bed and put toothpaste on my brush, which sounds very silly.

Marisa Wojcik:

2021, around the time Dick first began filing grievances to the state for what they were experiencing in the facility.

Dick:

We had a cook, a med-passer, and one or two aides during the day.

Marisa Wojcik:

For how many residents?

Dick:

I would say about 50 to 55 at the time.

Marisa Wojcik:

So what does that mean? Does that mean some people need help and they can’t get it?

Dick:

Right. It meant —

Lanea:

They wait.

Dick:

Some people can’t get —

Lanea:

They might be stuck on the toilet for an hour.

Dick:

You might lie in bed for two hours waiting for someone to help you out of bed. Also, we had an incident that had quite a major impact, I thought, when a med-passer could not find childcare. Again, I think it was a weekend morning. There was no back-up plan, even though a management person was in the office that day and it’s someone who had passed medications before but chose not to get involved. Did find — except, of course, to find a substitute eventually, but when 8:00 meds come at 12:30 or 1:00 or 1:15, that is really a delay. We’ve heard also of cases of people hearing their next-door neighbors in their apartments calling for help and seeming to be ignored for a long time.

Marisa Wojcik:

Do you feel safe living here?

Dick:

One big fear is fire, because so many wheelchairs and otherwise incapacitated or people with reduced capabilities are on the upper floor, with just elevators and stairs to go out.

Marisa Wojcik:

How does it all make you feel?

Dick:

I am very stressed.

Lanea:

Stress level is terrible.

Dick:

There are people who don’t come to the dining room anymore because of the stress level, and a couple of people have moved out.

Marisa Wojcik:

Fast forward to present day, new concerns have appeared.

Dick:

A nurse in January came and immediately set about gathering vitals and she left so no more vitals since then, but we went for months and months, maybe over a year, without having them done for everyone. But there seems to be no end to the number of staff who are willing to walk off their shift after an hour or two and just go home and leave one person in charge to take care of everybody all night.

Lanea:

Well, one thing, they don’t pay enough. When you get just poverty wages, you’re not very interested in coming to work.

Marisa Wojcik:

And still, some of the same issues persist.

Lanea:

One real concern is the lack of fire drills.

Dick:

Yes. But basically, we’ve been told, well, just wait there in your room and the firemen will come. We’ve filed grievances with the state as well. Not lately, we kind of burned out on that. Oftentimes, they just can’t substantiate what is supposed to have happened.

Marisa Wojcik:

How does all of that make you feel as you’re just trying to live your life?

Dick:

Depressed. I feel our needs — that many of our needs are ignored and that especially the emotional and psychological, I guess you’d say.

Frederica Freyberg:

Certified nursing assistants often perform much of the work in places like assisted living facilities or nursing homes, and the healthcare workforce report shows additional critical shortages of other frontline health workers across the state. For more on the ramifications of this for patients, staff and hospitals, we turn to Ann Zenk, vice president of workforce and clinical practice at the Wisconsin Hospital Association. Thanks for being with us.

Ann Zenk:

Thanks for having me.

Frederica Freyberg:

So how many vacancies are there right now for certified nursing assistants in Wisconsin?

Ann Zenk:

Nearly 1,800 across the state, and added to that, nearly 4,000 RN open positions.

Frederica Freyberg:

Has it ever been vacancy rates that high?

Ann Zenk:

You know, I think because our healthcare, hospital and health system workforce is larger than it’s ever been and these are historic highs, I think those levels are unprecedented also.

Frederica Freyberg:

What happens when there are not enough CNAs or RNs in a healthcare facility of any kind?

Ann Zenk:

So, you know, hospitals right now are experiencing a really big bottleneck in the availability of long-term care beds, like nursing home beds. The impact of that is that patients stay in the hospital longer than they need to, which stretches staffing thinner and also creates longer wait times in the emergency department as patients who need that acute care bed have to wait for another bed to open up.

Frederica Freyberg:

Because your report talks about something called the silver tsunami, and again, these nursing home bottlenecks. Describe what’s happening there.

Ann Zenk:

We’ve been talking at WHA and thinking about the impact of the retirements of the large baby boom population — generation, excuse me, because the baby boom generation is so large and spans a couple decades, we’re now seeing the silver tsunami in Wisconsin. 10,000 U.S. citizens turn 65 every day and that’s retirement age, right? In Wisconsin, about one in four individuals is at retirement age. That’s even ahead of the U.S. population where it’s about one in five. That means our healthcare workforce is shrinking. There’s an additional challenge for hospitals and health systems, because as we age, our need for healthcare increases. So just at the time our workforce is shrinking, healthcare demand is growing.

Frederica Freyberg:

So what does all of this mean for patients and healthcare providers themselves?

Ann Zenk:

We need to focus on growing our workforce faster if we’re going to keep up with demand, but we also have to figure out a way to increase capacity with the workforce that we have. So that means that, you know, we have to grow fast, we have to make better use of technology, we have to make sure our teams are operating at the top of their skill level. If we don’t do those things very effectively, we’re going to see longer waits in the emergency department. We’re going to see people maybe having to leave their own community and go to another community where there is an open hospital bed.

Frederica Freyberg:

How badly is this putting patients at risk?

Ann Zenk:

I think that it’s right now impacting people’s time and energy. I think ultimately, they get the care they need, but it might be farther away than they would like or than their families can visit. It might be, you know, we focus a lot on the right care in the right setting at the right time, so their rehab might be delayed if they can’t find that long-term care they need.

Frederica Freyberg:

You talk about some of the kinds of solutions that are under consideration, but what about the pay for some of these lower paid frontline workers, like CNAs. Is there a way to adequately increase that to attract and retain them?

Ann Zenk:

We are hearing from our hospitals and health systems that CNA wages are increasing as demand increases. A few years ago, CNA pay started at maybe $13 or $14 an hour. In our latest salary survey, the average starting salary is around $17 to $17.50 an hour and the median salary is around $19.50 an hour, so those wages are coming up.

Frederica Freyberg:

We don’t have much time left, but I know that there have been state investments and kind of CNA training programs and Governor Evers is calling for $100 million in his state budget to address the healthcare workforce shortage. Are policy makers, though, across the board hearing and understanding this problem?

Ann Zenk:

I think as the word gets out, as our report is published and shows doubling of vacancy rates in just one year, that message is starting to get across.

Frederica Freyberg:

All right. Well, Ann Zenk, thanks very much.

Ann Zenk:

Thank you.

Frederica Freyberg:

The state’s network of emergency medical services is crumbling and dangerously unreliable. That’s according to a new report from the Office of Rural Health. “Here & Now” reporter Steven Potter looks at the growing problems and proposed solutions.

Jim Colegrove:

This is a heartbreak. This is a tragedy.

Steven Potter:

Because when you call 9-1-1, you expect an ambulance to show up and show up soon but for some communities around the state, particularly rural ones, there’s a growing concern that emergency medical services won’t be there to answer calls. The problem, a staffing shortage.

Alan DeYoung:

We have a crisis not unlike other industries, like retail and otherwise, but staffing for EMS means life and death. It means somebody not showing up to a call, an ambulance not arriving. What we started to see in the last couple of years, departments have been closing, and sometimes there’s a mutual aid agreement for another department to come in and help out, but many times, towns, cities, villages are without EMS. They have nobody.

Steven Potter:

A new survey from the UW-Madison Office of Rural Health shows the extent of the problems. More than 40% of state EMS agencies had staffing gaps where no ambulance was available for emergency calls. And almost 80% of EMS agencies were called to cover an emergency in a neighboring community.

James Small:

We even saw that in 10 communities, there were services that reported that an ambulance never got to a call at all, that there was 9-1-1 calls requesting ambulances. They didn’t have staffing available and they never had an ambulance make it to a call.

Steven Potter:

At the heart of the current staffing struggles is the fact that, for decades, Wisconsin’s EMS operations have been built upon and almost exclusively been supported by volunteers.

Alan DeYoung:

Right now, 79% of our state actually relies on volunteers to staff their 9-1-1 calls, which is a huge amount if you’re talking about majority of the state relies on volunteers, some that might get paid a stipend, might not get paid at all, a lot of times having to pay out of their own pocket, so we have many rural areas that are using volunteers to kind of subsidize the cost of EMS

Steven Potter:

Paul Blount is the chief of the EMS operations for the Cambridge area.

Paul Blount:

The combination model has become a popular solution. We have several individuals that work here full-time. This is their full-time job, and then some part-time members and then community volunteer paid on-call members, and that is a pretty popular staffing strategy and what it does is help address the need for 24/7/365 ambulance coverage.

Steven Potter:

Chief Blount started as an EMS volunteer himself years ago. He understands why it’s hard to keep enough Paul Blount volunteers to staff ambulances.

Paul Blount:

Family demands, work demands, and then just a struggle to just find people to do the job and to volunteer especially to do the job.

Steven Potter:

The prime example of the EMS staffing shortage is happening there in Lake Mills in Jefferson County.

Jim Colegrove:

Unfortunately, a bit over a year ago, we realized that we were not being successful at recruiting and retaining people. We were also having some financial difficulties. With all of that going on basically, we have had to make the decision that we are going to be closing our doors here on June 30th. Because we have been serving this community, our friends, our neighbors for close to 50 years, that in itself is the — closing the doors is just tragic.

Steven Potter:

Whether you’re a paid emergency medical technician or even an EMS volunteer, extensive training, education and certification from the state is required. And on top of that, Jim Colegrove notes, the work isn’t for the faint of heart.

Jim Colegrove:

This is a dirty job. This is very, very difficult. You are dealing with human beings in some of their worst possible times and you have to have a lot of empathy for those people and you have to be willing to be working in an environment where somebody is throwing up on you. You are working a code and you are doing CPR on somebody that you know who lives just down the street, that type of thing, and so it is very emotionally charged, but it is generally very much a sense of wanting to give back to a community.

Steven Potter:

Lake Mills is now in the process of joining the Cambridge area EMS group. A number of EMS agencies around the state have entered into similar consolidation agreements with neighboring communities. A temporary solution is asking residents, through ballot referendums, for more money, but for a long-term solution, EMS officials are seeking more stable funding from the state.

Alan DeYoung:

The state really, right now, needs to step in, needs to provide permanent funding.

Steven Potter:

DeYoung says such funding will need to be substantial and sustainable.

Alan DeYoung:

We’re talking about $500 million in a budget hopefully for a two-year budget here but that’s really to provide every department about what they need. Like I said, some will get less, some more, based on how rural they are.

Steven Potter:

To make that funding dream a reality, EMS operators have begun knocking on lawmakers’ doors at the Capitol.

Jesse James:

As far as I’m concerned, out of police, fire and EMS, EMS is the number one priority.

Steven Potter:

Eau Claire area State Senator Jesse James has worked hand in hand with EMS providers on emergency calls as a former police and fire chief in Altona. He says he knows how necessary these services are.

Jesse James:

It’s essential for all of us, whether you’re in the urban area or rural area, we need to have these services available to serve our communities.

Steven Potter:

Senator James says he wants to explore financial incentives for smaller communities to consolidate their EMS operations, but he’s unsure how much Republican legislators are willing to give to EMS agencies in their state budget.

Jesse James:

There needs to be some money put into it. I don’t know if they would reach that $500 million mark, though.

Steven Potter:

EMS officials say they also need more money for recruitments efforts to help attract more potential employees to the field. According to the state Department of Health Services, over the last decade, ambulance patient numbers have nearly doubled from about 500,000 patients per year to more than 900,000. Over that same 10 years, however, the number of EMS providers has gone from 20,000 to just 21,000, an increase of only 5%. And, DeYoung says, those figures are about to get much worse.

Alan DeYoung:

We are actually estimating about 25%, 26% of all licensed EMS providers are probably going to let their license lapse this renewal year. You’re talking about a workforce cutting it down by a quarter.

Steven Potter:

EMS leaders hold out hope that state lawmakers will respond to the need.

James Small:

I think that there is definitely intent in the legislature to try to address this issue. It seems to be very high priority. I’m getting contacted by legislators numerous times a week wanting information on the system, wanting to know some of the results of the survey and so on. I don’t know what EMS 2.0 is going to look like, but we know that EMS 1.0 has run its course.

Steven Potter:

For “Here & Now,” I’m Steven Potter in Lake Mills.

Frederica Freyberg:

Most of central and west-central Wisconsin remain under a red flag extreme fire danger warning Friday evening. Warm temperatures and gusty winds drastically increase the chance of wildfires this week, prompting Governor Tony Evers to declare a state of emergency. The Wisconsin DNR reports they have responded to nearly 100 wildfires since last Friday, including a 3,000-acre fire in Monroe County that crews including from the Wisconsin National Guard worked to contain. Officials are urging extreme caution until conditions so favorable to wildfires improve.

Democratic Wisconsin U.S. Senator Tammy Baldwin this week announced she is running for a third term. A challenger has not yet officially announced. One thing is likely, another scorched earth campaign, political vitriol on steroids. That seems to be the Wisconsin way. In fact, a new report from the Center for Communication and Civic Renewal at UW-Madison shows Wisconsin’s political divides are breaking citizens apart. Center director and journalism professor, Michael Wagner, joins us with details, and thanks very much for being here again.

Michael Wagner:

It’s great to see you.

Frederica Freyberg:

So what are the most prominent symptoms of Wisconsin’s political divide? Your survey calls them civic fractures.

Michael Wagner:

Yes. Some of the examples we see of that are in how politics and our deep commitment to our political identities is now shaping how we engage in everyday conversation with people. Nearly 2/3rds of us now have said we’ve stopped talking policies with somebody. We might talk about the Badgers or the Packers or the weather, but we won’t talk politics anymore. Then for almost one in five of us, we’ve cut a friend or family member out of our lives because of political disagreements. Now that might be because we don’t want to hear what the other side has to say and don’t want to have to engage their ideas or it might be because the other side is telling us who we are is invalid or maybe we feel dangerous in some conversations or we might be in danger, and so it’s hard to know exactly what’s driving these things, but people are retreating from the kind of deliberation that is fundamental to democracy.

Frederica Freyberg:

How and why did this happen?

Michael Wagner:

It’s gotten worse since Act 10. Over the last decade plus, we’ve seen a growing fracture in these kinds of measures of our civic health, and so 11 years ago, about 30%, 33% of Wisconsinites said they’d stop talking politics with a friend. Now it’s 60% and so it’s really increased. The way that our legislature and governor deal with each other has gotten more acrimonious. Our political ads have gotten more acrimonious. National politics is more coarse and fraught with all kinds of things that are both uncivil on the one hand but sometimes outright dangerous and disturbing on the other, and so all of these things are happening at once.

Frederica Freyberg:

Why is the messaging that makes people angry, distrustful and even fearful so resonant?

Michael Wagner:

Well, people are often driven partially by emotions and their decision-making and it’s easier I think to tap into people’s fear and it’s easier to say to people, you’re not the reason for your problems and it’s not broad structural things that are really hard to fix; it’s those people, that group that we don’t like is why your life is harder, and so it becomes easier to dislike that group and support the people that were telling you that that’s the problem.

Frederica Freyberg:

How surprising is your finding that 60% of strong Trump supporters say they could have to use force to save the traditional American way of life. 60%.

Michael Wagner:

Yeah. We are interested in how these civic fractures might lead to anti-democratic outcomes like using violence to achieve your political means. And for most Republicans, they say, no, we don’t like this idea, but among the one-third of Republicans who are really strong supporters of President Trump, 60% of those folks say they might endorse that idea. Saying you endorse the use of force is different than actually doing it but this is an alarming and disturbing result. So we need to keep our eyes on that as a society about there are other ways to solve our problems other than using violence.

Frederica Freyberg:

So your report says that this diagnosis is grim but there is reason for hope. Like what?

Michael Wagner:

Lots of things. First, overwhelming bipartisan majorities of Wisconsinites favor political compromise as compared to sticking to your principles even if nothing gets done. Overwhelming majorities across parties believe that their vote was counted, whether it was in person, absentee, by mail. There’s strong confidence in that. There’s strong support for non-partisan redistricting, which is a fairer way to engage in representation. And there’s strong support for the separation of church and state across political parties. And so there are foundations we can build on to improve democracy in our state.

Frederica Freyberg:

It seems hard to understand how there is 80% of survey respondents believe that their vote was counted, will be counted. How does that square with election denial and all of this misinformation that we’ve been listening to for 2-1/2 years?

Michael Wagner:

Well, we’ve heard it coming really from one corner of political discourse and we’ve seen most of the people who are open to that idea are these tend to be strong supporters of former president Trump. He’s not relented on that. Many Republicans in government will either agree with him or won’t directly disagree and so there’s this ambiguity there that lets people feel like well maybe seems like the election was reasonably conducted but maybe it wasn’t or maybe there were some problems even though all of the audits, all of the lawsuits, all point to the same story, which is that we do this really well in Wisconsin.

Frederica Freyberg:

Why did your center embark on this study?

Michael Wagner:

We really care about ways we can reknit together the civic fabric. This is a state that has elected people in statewide elections from both parties. It’s a state that has had very liberal and very conservative lawmakers represent us and we’ve been able to do that in ways where we could talk together, work together, try to solve problems together, and as those things fracture, becomes harder to do that. We want to understand the problem so we can help articulate a solution.

Frederica Freyberg:

Mike Wagner, thanks very much.

Michael Wagner:

My pleasure.

Frederica Freyberg:

For more on this and other issues facing Wisconsin, visit our website at PBSwisconsin.org and then click on the news tab. That’s our program for tonight. I’m Frederica Freyberg. Have a good weekend.

Announcer:

Funding for “Here & Now” is provided by the Focus Fund for Journalism and Friends of PBS Wisconsin.