Franklin Hospital, a small critical access facility in southeastern Illinois, is used to having its 180 employees jump in to cover for each other, says Rhonda Boehne, the hospital's director of human resources.
But changes made to new federal family and sick leave rules will make that harder and, some rural healthcare providers say, maybe even impossible.
Providers initially weren't required to follow the Families First Coronavirus Response Act as they treated the pandemic's patients but revisions made last week by the Labor Department change who is entitled to COVID-related family and sick leave.
Under the new law, employers with 500 or fewer employees receive tax credits for giving workers paid time off for coronavirus-related reasons. The revisions narrow the definition of who is exempted from the rule to include only those who are providing healthcare services or functions integral to patient care. That means food service, environmental services and registration staff are entitled to time off, while those providing direct care to patients are not.
But the pandemic has proven how essential all hospital workers are, especially those maintaining cleanliness in patient rooms.
"Essentially what this rule does is that it comes in, and it splits the hospital in two," said Franklin's CEO Jim Johnson. "I can't let half of my people get a benefit."
Instead, Johnson is going to make the benefit available to all employees and use Coronavirus Aid, Relief, and Economic Security Act funding to cover the cost of hiring through a temp agency or paying overtime. But he worries how that could potentially affect his team.
As part of the FFCRA, employees are entitled to 80 hours of paid sick leave if they are caring for someone under quarantine, are under quarantine themselves, are experiencing COVID-19 symptoms and are seeking medical attention, or their child's school or place of place of care is closed or unavailable because of COVID-19.
"If we had a breakout, we could get really short staffed," Johnson said. "What I've said from the very beginning of COVID-19 is that we're going to do the very best that we can with the resources we have."
Staffing is already a challenge, and there isn't a trained workforce in the community that can fill in, he said.
In rural areas, there are 20 fewer physicians per 10,000 people than in urban areas, according to the National Institute for Health Care Management Foundation, a not-for-profit, nonpartisan organization. And nationwide, 60% of healthcare providers who responded ot a Medical Group Management Association Stat poll in 2018 reported facing shortages of applicants for non-clinical positions over the past year.
"For a lot of these positions, it's not like we can go out and get contract services," Johnson said.
The plan is for everyone to help cover where needed, and Johnson and other administrators are ready to help fill in registering patients and performing other duties, if the need arises.
"If there was an issue, we'd all just band together and get it done," Boehne said.
Darrold Bertsch, CEO of Sakakawea Medical Center, a 13-bed critical access hospital, and Coal Country Community Health Center, a federally qualified health center in North Dakota, also plans to make all employees eligible for the FFCRA family and sick leave benefit.
"We don't differentiate here whether or not you're a direct care provider or whether your indirectly involved in that patient's care," Bertsch said. "They're all essential to what we do as healthcare providers."
Patient needs won't be met, he said, if someone isn't there to handle registration when someone comes in, to prepare food or to clean. Yet having workers out will put a strain on an already stretched workforce.
"We don't know where we're going to get staff from," Bertsch said. "It just ends up being a real challenge for us to provide to those who need us."
But he also thinks it's important to treat all employees equally.
"We are going to apply this as uniformly to all of our staff as best we can. We think they're all vital," Bertsch said.
The temporary FFCRA is in effect through the end of the year, according to the DOL.