Users in the medical market include hospitals, clinics, insurance companies, laboratories, private practices, and individual households. Hospitals, like most businesses, are adopting a lean staffing strategy and use temporary help to support a core of permanent employees. A major factor in the demand for temporary hospital personnel is the fluctuating patient population, which varies on a day-to-day basis. An occupied bed requires specific staff services. A low bed count represents lost revenue to the hospital, and it must adjust its payroll accordingly. Those occupations most affected include nurses, housekeepers and food-service workers.
The trend toward reduced hospital stays began when the government (Medicare/Medicaid) changed payment policies on specific patient treatments. It will now pay only for a predetermined number of days for each procedure. Consequently, hospitals are discharging patients earlier, and thus people are recovering from surgery, strokes, and other medical conditions in convalescent centers and private homes. A nurse in the home substitutes for a nurse in the hospital. Nurses may supervise such care as intravenous therapy, medication, and respirator support.
Temporary Nurses
The U.S. Department of Health and Human Services predicts that by 1990 there will be a 40 percent shortage of nurses. While hospitals use temporary nurses to supplement their own staff, even medical temporary help firms are expected to feel the pinch.
In the early 1980s many nurses were put out of work by diagnosis related groups (DRGs). The DRG system allows a hospital to receive a fixed payment for a medical procedure, regardless of whether the hospitals cost is greater or less than the payment itself. This system is used by the government to reimburse hospitals for the care given to Medicare subscribers. Hospitals reduced patient stays to curb loses, and one area of cutbacks was the nursing staff. Now, just a few years later, frightened by the shortage, hospitals are trying to entice these same nurses back into their employ. In the interim, enrollments in nursing schools have dropped, and many nurses have moved into other areas of business and health care that pay higher wages and offer better working conditions.
Joel A. Klarreich, executive vice-president of Cosmopolitan Care Corporation, a regional medical temporary help service, says, "In New York City and all over, there is a critical shortage of skilled nurses. Recruitment is a real problem... RNs can pick and choose the type of employment they want." Klarreich feels the shortage may be an outgrowth of the women's movement: "Nursing is not the profession of choice now. Other career opportunities are open to women who may have chosen to be an RN previously."
Home Health Care
Primary users in this field are families who need health care for a family member. In general, however, the family doesn't pay; rather, the paying client is the insurance company or government (Medicare/Medicaid). This type of care is usually set up indirectly through hospital discharge planners, physicians, and social workers. It can sometimes be difficult for a temporary service to locate the appropriate source of payment, and those being reimbursed by Medicare or Medicaid must be certified to receive such payments. Home health-care users are different from most customers of a temporary help firm, because they are often one-time users which translates into little repeat business. Specific examples of this type of temporary assignment include assisting a patient who is recovering from surgery; caring for a terminally ill person; helping a new mother with baby care; caring for a patient with a condition such as kidney dialysis; and working with a stroke victim.
Two widely used categories of home health-care occupations are the companion and the home health-care aide. Typical assignments include custodial patient care through a terminal illness or caring for an elderly person. A home companion can help an elderly, handicapped, or recovering patient with house-cleaning, cooking, and general errands. A home health-care aide has had previous training, either from the temporary service which employs him or her, or from a school or prior work experience; many have participated in certificate programs. Most private household assignments are long-term, that is, meaning two months or longer. All individuals, who work for a health-care service, are usually given a thorough screening, have had their professional licenses checked, and undergo a health examination.
Many medical temporary services include office support staff specific to a health-related setting. Molly Landon of Medical Society Personnel Service, in Washington, D.C., adds, "Medical temporary help is an area of the temporary employment field which is growing in leaps and bounds... Unfortunately, the current AIDS scare has caused some clinical medical workers to transfer to medical clerical jobs."
