Sep. 10—After eating his Thanksgiving meal this past fall, Shawn Reynolds felt a strong stomach pain.
He went to lie down to let the pain pass, but soon, it became so intense he headed to a local hospital, according to his daughter Jordan McLatchy.
"By the time they got to the emergency room," McLatchy, of Dublin, recalled, "he was in so much pain that he couldn't get out of the car, so my mom had to get a wheelchair."
Once inside, McLatchy said her father waited hours for help. The Peterborough resident tried to be seen sooner, pleading to hospital staff that he needed immediate assistance.
Despite his efforts, McLatchy said the high levels of COVID-19 at that time, coupled with it being a holiday, left workers stretched thin.
It would be four hours until he was evaluated, she said.
"They took him in for a CAT scan of his stomach, and that kind of changed the urgency very quickly," she said. "They were, I think, finally realizing that he wasn't just overreacting."
The scans showed Reynolds' intestines had perforated, and he was in septic shock. After being transported to a larger hospital, he was immediately taken into surgery.
He wasn't stable enough to be awoken after that, McLatchy said, so he was placed in a medically induced coma. He needed another seven surgeries over the course of one month before he came to.
In addition to his ongoing intestinal issues, Reynolds is now dealing with several medical conditions, like muscle atrophy from being bedridden for so long. Just recently, he began to walk again.
"I wouldn't blame [the hospital]," McLatchy said. "I was obviously very upset that night ... but, I mean, it is what it is ... I'm sure they were doing the best they could."
Delays like this are no longer abnormal, with the COVID-19 pandemic exacerbating pre-existing shortages in workers across the health care sector.
These staffing shortages are considered the top patient safety concern in the country, with those seeking care enduring longer wait times or being turned away entirely, according to ECRI, a nonprofit patient safety organization.
Health facilities and volunteer-based groups in New Hampshire have tried to address the problem through initiatives like pay increases, sign-on bonuses and educating students about jobs available in the field.
But, despite their best efforts, advocates say this shortage can't just be fixed with internal shifts.
"Right now, it's just impossible to see a path forward without help," said Brendan Williams, president and CEO of the Pembroke-based N.H. Health Care Association.
An unprecedented decline
The shortage of health care workers is nothing new.
For years, advocates have tried to call attention to the crisis, with older generations of employees retiring out of the workforce at a rate outpacing those entering it.
More than 20 percent of Cheshire County's residents are 65 or older, according to the most recent data available from the U.S. Census Bureau. The county also had the highest percentage of physicians 75 and older in the state in 2019, at 27.7 percent, data from the Rural Health Information Hub show.
The COVID-19 pandemic made the already bad situation dire, experts say, with a surge of people leaving the field due to burnout and increased stress, as well as sicker patients — physically and mentally — requiring care.
In March, the American Hospital Association called the current shortage a "national emergency," projecting the overall dearth of nurses to reach 1.1 million by the year's end.
But, it's not just nurses. The shortage — once targeting singular jobs — has left no health care position untouched, affecting doctors to therapists to entry-level staff.
Greg David, economist for the Economic and Labor Market Information Bureau of the N.H. Employment Security office, said that in July, there were an estimated 91,300 workers in the state's health care sector. This is 3.7 percent below pre-pandemic levels.
"[T]his is an unprecedented decline. Health care is usually a 'recession-proof' industry, since demand for healthcare services is not strongly affected by overall economic conditions," he said in an email. "During the Great Recession, health care employment in New Hampshire increased."
In some instances, the lack of workers has resulted in delayed care.
Reynolds was an extreme case of that. For others, it's as simple as not being able to find a local provider.
Mike and Sharon Hartz, both 75, moved to Hancock from Wisconsin in December to be closer to their grandchildren.
The couple needs to see a few specialists for their routine care, such as in dermatology and periodontics. Mike said that, though they've had luck with primary care, finding specialists has been burdensome.
He's sought out care in Hancock and Keene, and has been met either with a months-long waitlist or no care options at all.
One specialist, Mike recalled, booked him an appointment three months out.
"There aren't enough specialists around, and it takes forever to get in touch with one, it takes forever to get an appointment. And then, you don't even know if you're going to like them ...," Mike said. "It's going to be three months [until] we find out if this is someone we can deal with or be able to work with."
If the provider isn't right for them, Mike said they'll likely have to travel for care, such as to Concord or Boston.
This would be "really inconvenient," he noted.
"It's unfortunate because it's a considerable distance," Mike said. "You'd hope that with two hospitals within an hour away, you'd be able to find what you need."
The shortage, by numbers
Across the Monadnock Region, the shortage is being felt in virtually every health care setting.
At Cheshire Medical Center in Keene — which currently employs just over 1,500 people — there are more than 200 full-time, part-time and per-diem vacancies, according to Lisa Sandstrum, vice president of human resources.
She said this rate is "much higher" than pre-pandemic numbers.
"I've never seen vacancies at this number ... and it's taking longer to fill them," Sandstrum said.
The cost of living and lack of affordable housing in the Monadnock Region — Sandstrum and others interviewed by The Sentinel noted — have contributed to the difficulty filling positions.
Dan Gross, the Dartmouth Health affiliate's chief financial officer, echoed this.
"[The housing shortage is] just like the nursing shortage. Once you realize you have a shortage, it takes a really long time to get out of it to develop housing and build it," he said. "It's a double whammy for us."
Monadnock Community Hospital in Peterborough was averaging about 30 openings per month prior to the pandemic, according to John Sansone, vice president of human resources. Now, the hospital, which employs 551 people, is seeing about 75 to 80 monthly.
And back in Keene, there are about 50 positions open at Monadnock Developmental Services, "way higher" than before the pandemic, according to Executive Director Mary Anne Wisell.
The social services organization provides assistance, such as in-home support, to people with developmental disabilities and children with chronic health conditions.
"We have program managers that have to cover [other] programs, and many of them are working in excess — 60, 70 hours — covering shifts," Wisell said.
She added that the lack of workers puts a direct strain on patients' families.
"I can't overemphasize the impact that it has on families ... The bulk of the pressure ends up on families to fill the gaps, and that is extraordinarily difficult," she said.
At Maplewood Nursing Home in Westmoreland, 67 percent of the licensed nursing assistant jobs are vacant, according to Administrator Kathryn Kindopp.
The county-operated facility is also struggling to hire for entry-level positions, like housekeeping, so current employees are picking up the weight.
"What we've had to do here, almost on a daily or weekly basis, is analyze what our resources are and redeploy them where the needs are ...," Kindopp said. "It's a lot of overtime, it's a lot of missed time off ... and what's really tough is we don't see an end in sight."
Maps Counseling Services in Keene and Peterborough is at an "all-time low" of clinicians on staff, according to interim Executive Director Jill Burns. The nonprofit usually has about 20 therapists, but is down to 13.
Maps itself doesn't have an official waitlist, Burns noted, but some individual clinicians will keep one.
"In general, it's a couple calls a day or at least a handful of calls a week that [Maps] would potentially have to turn away," she said.
It's a similar scenario at Monadnock Family Services in Keene and Peterborough, the region's community mental health center.
Executive Director Phil Wyzik said the nonprofit, which has 184 employees, has about 40 open positions.
Monadnock Family Services has a waitlist for adults and kids, though Wyzik said the wait times are in line with what it was seeing prior to the pandemic.
Still, the lack of workers has made it challenging for Monadnock Family Services to fulfill its mission, Wyzik said.
"We don't believe, in our organization, that this is a short-term phenomenon, that if we just hunker down and weather it, it'll die down. I'm not making that assumption," he said. "I believe this is a long-term phenomenon that we have to adjust to address ... It's going to make for hard times."
Solutions underway; more help needed
All of the health leaders interviewed by The Sentinel said they had implemented — or continued to follow — recruitment and retention strategies internally amid the current shortage.
These ideas overlapped across the sector, consisting of pay raises, sign-on bonuses, offering free training programs for staff to further their skills and talking with students about potential health career opportunities.
These initiatives can be helpful, but nearly all officials said they needed a more concrete solution.
"It feels like we needed answers two years ago," Wisell said.
To help, statewide and regional efforts have taken shape — some years in the making.
The N.H. Sector Partnership Initiative, launched in 2017, is a statewide initiative to help businesses in select industries, including health care, address their workforce needs, according to its website.
The industry-driven, volunteer-based approach calls on health leaders to meet with their peers in regional groups to identify and create solutions for their concerns.
The Monadnock Region Healthcare Workforce Group is one of those collaboratives, with about 10 to 12 participants, according to Chair Cathy Gray.
The local group has had success in passing various state bills aimed at helping the shortage, such as one allowing for nurses from surrounding states to be temporarily licensed in New Hampshire while their application is processed.
A licensed practical nurse program was also revived at River Valley Community College due to the group's advocacy for it amid the pandemic. It shut down in 2015 due to a perceived lack of need at that time, according to Gray.
"As the staffing crisis was predicted and approaching our group realized we needed more LPN training programs. Individuals had to go out of state ... to be trained," Gray said in an email.
River Valley was the first and only college to reinstate the program, Gray noted, offering it in Keene, Laconia, Lebanon, Littleton and Manchester.
As of June, Gray said 259 nurses had completed the year-long program. By January of 2024, the Monadnock group hopes for every region in the state to have an LPN program up and running.
Additional work by the group includes the launch of a health career camp in 2019 for middle-school students and, in 2019 and 2021, it held a health care career expo for high-schoolers.
Now, the group's focus is on increasing the number of area workers, with an aim of bumping that up 20 percent by the year's end.
This will be done through data collection on local vacancies; working with other groups addressing barriers adding to the shortage, like lack of housing and child care options; and looking into potential opportunities for refugee resettlement, according to an outline of the group's goals.
"We're really trying to hold our feet to the fire," Gray said.
Aside from the sector partnerships, another statewide workforce initiative is at play.
Health care, education and state leaders created Giving Care: A Strategic Plan to Expand and Support New Hampshire's Health Care Workforce. Launched in March after two years of strategizing, the plan outlines 107 immediate and long-term solutions.
These recommendations fall into four categories: recruitment and retention; removing or rethinking policies that prevent workforce development; collecting and using data for decision-making; and creating a group to keep the plan moving forward.
Kim Firth, program director for the Endowment of Health, which funds the initiative, said the group "very intentionally" put this plan on a timeline of two years or less.
But, without investment from the state, she said it'll be hard to get some of these recommendations off the ground.
For that, Firth said advocates are identifying which of the plan's ideas should be prioritized to get into the state budget.
"I think failure to do so could have dire consequences," she said.
At the N.H. Health Care Association, Brendan Williams said the organization is trying to prompt action by raising awareness within the Legislature on the shortage, whether it be vouching for an increase in Medicare and Medicaid rates or asking for temporary funding assistance through the American Rescue Plan Act.
Like Firth, Williams said he thinks state-level action is needed for substantial relief. But, any changes in the budget wouldn't take effect until July.
The bridge to that point is what's the most unstable — and worrisome.
"I'm afraid," Williams said, "that there's no silver bullet at this point."
Funding for the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab. Olivia Belanger can be reached at 352-1234, extension 1439, or firstname.lastname@example.org. Follow her on Twitter @OBelangerKS.