An aerial view of the Jay Nixon Forensic Center, the 300-bed maximum security psychiatric unit that opened in 2019 at Fulton State Hospital. The hospital is 400 employees short of full staffing. (Department of Mental Health photo)
The Department of Mental Health canceled a $16 million project to renovate a building at Fulton State Hospital for use as a sex offender treatment center because there is no realistic expectation of finding staff to run it.
Lawmakers appropriated the money last year from federal COVID-19 recovery funds. Department Director Valerie Huhn told legislative budget committees last week that the state psychiatric hospital is understaffed by 400 employees.
“I don’t see a universe where I fill 400 vacancies at Fulton State Hospital just given what we know about the workforce in the Fulton area,” Huhn said last Monday to a House appropriations subcommittee.
Across state government, the refrain is the same – jobs are left vacant and turnover impairs services to thousands.
Paul Kirchoff, executive director of the Missouri Veterans Commission, told a House committee that only half of the 1,238 nursing home beds for veterans are occupied because he cannot hire enough staff.
“We are admitting, but very slowly,” Kirchoff. “We have to keep a percentage of staff available to take care of those veterans.”
With unemployment low and wages in private industry rising, Kirchoff said the state must respond in ways that slow turnover, allowing employee rolls to be rebuilt. His agency must compete against private-sector signing bonuses of up to $5,000 for certified nursing assistants and $10,000 for registered nurses.
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Part of the answer is the biggest pay raise proposal in living memory for state workers.
Gov. Mike Parson is asking lawmakers to boost pay 8.7% in time to include the money on March paychecks and increase the night differential for direct care workers to $2 an hour from the current 30 cents.
During fiscal 2022, which ended June 30, state employees received a 7.5% pay raise – 2% in the original budget and 5.5% from supplemental appropriations. The base wage for state jobs was also raised to $15 an hour.
The House Budget Committee will hold a hearing Tuesday on the supplemental budget proposal with the raise, Chairman Cody Smith, R-Carthage, said.
In a January interview, Smith said he was not convinced the full 8.7% was necessary but he’s ready to approve raises at some level.
“It makes sense that as the private sector increases their wages, the state does that as well,” Smith said.
The increased differential has his full support, Smith said.
“It’s logical that it’s harder to hire those folks,” he said. “Paying them more to work in those needed jobs, in the less desirable shifts, makes perfect sense to me.”
During a hearing of the Senate Appropriations Committee on Thursday, no one questioned the cost of the raises, which total $183 million through June 30, including $83.4 million in general revenue.
The staffing shortages across state government are so acute that the pay raise for all jobs is the clearest way to combat the problem, Senate Appropriations Chairman Lincoln Hough, R-Springfield, said in an interview.
“It’s hard to say what concerns you the most,” Hough said. “What the governor is trying to do is raise the salaries for all of them, so maybe that we get away from this.”
State government counts employment in what the budget calls full time equivalents, or FTE. One FTE is equal to 2,080 hours of employment in a year, or 1,386 hours of overtime.
The budget documents showing how money is allocated to employee costs track more than dollars spent for salaries and benefits. Each line for payroll spending in an appropriation bill also has a note that the total hours worked to use the money should not exceed a fixed number of FTE.
Lawmakers budgeted 53,578 budgeted FTE for fiscal 2022, about 2% less than fiscal 2017. Agencies used just over 97% of those hours in fiscal 2017, but just 87.5% in fiscal 2022.
While several departments, notably Mental Health and Corrections, exceeded their budgeted personnel hours in fiscal 2017 due to overtime, none did so in fiscal 2022. The highest use rate among the 16 executive departments was Public Safety, at 99.95%, and the lowest was Labor and Industrial Relations, at 75.4%.
Even the governor’s office has a staff shortage. In fiscal 2022, Parson’s office only used 72% of its allotted FTE.
Departmental budget requests for the coming year, replete with notes on the impact of turnover and staff vacancies, tell a part of the story:
- In the Department of Corrections, where only 81% of budgeted hours were used in fiscal 2022, more than half the people hired as entry-level correctional officers quit within six months.
- In the Department of Transportation, where turnover reached 18% in fiscal 2022, the median tenure of employees has fallen from 11.3 years to 8.3 years over the past five fiscal years.
- Turnover reached 57% among direct care assistants in the Department of Mental Health’s Developmental Disabilities Division, meaning 600 people around the state are unable to access appropriate placements.
- Average wait times for the Department of Revenue’s call center, just over 4 minutes during fiscal 2020, were more than 23 minutes in fiscal 2022.
The state counts turnover as the number of full-time people who leave employment divided by the total FTE in a program. Turnover reached 29% in fiscal 2022, but has leveled off in the current year, said Dan Haug, the state’s budget director.
“To get a trend line that is that steep to bend is quite an accomplishment,” Haug said in testimony to the House Budget Committee. “We feel very comfortable that what we are doing is something that the state can afford and that makes a difference.”
The cost for the pay plan for a full year is estimated at $273.6 million, from all funds, with about $125 million from general revenue. The increased differential accounts for about $15 million of that cost.
The extra money in the differential increase will help persuade corrections officers to work night shifts, Anne Precythe, director of the department of corrections, told the Senate Appropriations Committee.
“Most people that work with us have families and they want to see their family and the current rate is 30 cents for these back shifts,” Precythe said. “And that’s just not enough to incentivize people to want to work that shift.”
Money is not the issue.
The state general revenue surplus stood at $4.3 billion on June 30 and is expected to grow another $600 million in the current year. If lawmakers approve Parson’s budget as written, and double-digit revenue growth slows to a trickle by the end of the fiscal year, the surplus on June 30, 2024 is estimated to be $3.8 billion.
The vacancies in state government alone are leaving far more unspent than the pay raise would cost. Lapsed general revenue, counted at $561 million in the current year, was less than $150 million in fiscal 2017, in large part due to vacancies.
Budget documents from the Division of Personnel put the cost of turnover in state jobs, in both hard costs such as paying unused vacation and soft costs like lost productivity, at $179 million in fiscal 2022. It is estimated to be $221.6 million in the year that begins July 1.
The division reported that it takes 63 days, on average, to fill a job after it is posted.
The state was advertising 954 jobs on the Indeed employment database as of Friday.
Impact on services
In this year’s budget, Fulton State Hospital is authorized to employ the equivalent of 1,007 full time workers. In the year that ended June 30, it used just 718.
That reality is forcing the decision to abandon plans to consolidate the Sex Offender Rehabilitation and Treatment Services program, currently split between Fulton and the Southeast Missouri Mental Health Center in Farmington.
The building selected to house the program in Fulton, the former Biggs Forensic Center, became available for use when the 300-bed Jay Nixon Forensic Center for the treatment of maximum security individuals committed to the department opened in 2019.
Before the new center opened, Biggs was described as the most dangerous place to work in state government, with workers’ compensation claims of about $4 million annually.
The employees currently assigned to the Fulton sex offender unit will be reassigned to the main hospital, Huhn told lawmakers.
“So instead of filling 400 vacancies, I need to find only 200 to 250,” she said.
There are 225 people in county jails deemed mentally unfit for trial and ordered into the custody of the department who are waiting for a bed. Huhn said that she had 15 available beds statewide in all psychiatric facilities and 40 that would be open if she had staffing.
The alternative plan, she said, is to direct services to the people waiting in jail, with a goal of getting the waiting list below 25.
“If you’ve got 225 people in jail, they are decompensating every day,” Huhn said. “They are, they’re not getting any support at all. It’s going to take longer to get them restored or able to return to the community.”
The Independent has documented numerous other ways vulnerable Missourians are getting sub-par services and stressed state employees are coping – or not – with difficult jobs.
The Children’s Division in the Department of Social Services, responsible for investigating allegations of child abuse and neglect, had 42% turnover in fiscal 2022. The director in April described his employees as “drowning” under a heavy caseload and workers themselves saying the job was “impossible.”
Parson’s budget includes 100 new FTE for the division. The department turned down lawmakers who offered to add 50 positions during last year’s budget work.
“What has changed from when we tried to add 50 positions and were told they were not needed?” Hough asked in a recent Senate hearing.
“We have new leadership over there that has taken a fresh look at it,” Haug answered.
In May, Missouri residents applying for food assistance by phone had to wait on hold an average of 56 minutes for an eligibility interview. And in June, applicants for Medicaid were waiting up to 115 days for their application to be processed.
The need for employees is especially acute in central Missouri, with two prisons in Jefferson City and three in adjoining counties, including one in Fulton where along with the mental hospital the state also operates the School for the Deaf.
During Huhn’s testimony before the House appropriations subcommittee, she said the department still intends to consolidate sex offender treatment in one location but has yet to determine where.
Rep. Mike Stephens, R-Bolivar, who is also chairman of the House Health and Mental Health Committee, summed up the state’s problem finding employees in the Fulton area for the four freshmen on the subcommittee.
The staffing issues at Fulton State Hospital have been a growing problem for several years as wages go up in private industry.
“You can leave the state hospital, go to work at the warehouse, and you will make more money,” Stephens said, “and you will not be assaulted or spat upon.”
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