Staffing concerns at the Kane Regional Centers don't change much year to year. As they continue to serve nursing-home patients in Allegheny County, nurses, nursing assistants and other staff work long hours for lower pay than hospitals can offer. Taxing work conditions that contribute to staff turnover. But there is another variable that persists and goes against best practices of a balanced work environment. Overtime.
Year after year, PublicSource analyzes data on salaries and overtime at Allegheny County departments, including the Kane Regional Centers, the chain of four county-owned nursing homes. The Kane facilities always stand out for overtime, leading to concerns about how much overtime is good for employees and for the care of the residents. But each year, the answer is the same: Managing overtime is a regular challenge and recruiting new workers, especially nurses, is difficult.
Between 2015 and 2016, the workforce at the Kane Regional Centers has stayed about the same. Meanwhile, overtime has increased.
According to the data, Kane employees earned more total overtime than workers in any other department. This is due in part to Kane having the most employees, though they don’t necessarily earn the most per person. On average, a Kane employee earned nearly $6,000 in overtime last year. The department-wide overtime figures for the past few years look like this:
Judging by Allegheny County’s annual budgets, it would appear that the Kane Regional Centers are spending much less than it is allocated on its workers even as they rely on employees to work more overtime at a rising cost to the county.
For the last few years, the Kane facilities have spent less on employees than was budgeted. In 2014, Kane spent $443,000 less than what was budgeted for personnel. Then, in 2015, Kane was under budget by $2.9 million. That trend continued last year with the Kane Centers spending $3.3 million less on personnel than it had budgeted.
Dennis Biondo, the executive director, said timing is the reason there are multi-million dollar differences between what the Kane Centers are allocated for personnel each year and what they spend. The county’s budget is set before the Kane Centers know precisely how much it will spend on paying its workers.
Still, he said, it’s necessary that the Kane Centers have more funding available than they may use because not having enough could hurt residents.
“Failing to provide for adequate appropriation in the budget could result in being unable to provide for the needs of the community,” Biondo said. Without needed funds, it could imperil the Kane Centers’ ability to accept new residents.
Bringing on new hires can be cheaper than paying the premium overtime rate to existing employees. But county officials say it’s not that simple when staffing a nursing home.
“In our 24/7 shops, it’s challenging to keep all of the shifts covered. It’s not that we need a whole other body, we just need a few hours,” said Mary Soroka, the county budget director.
Biondo said the Kane Centers evaluate overtime rates frequently and communicate with the budget office at least every two weeks. That allows them to pinpoint whether the overtime rates are a result of people taking time off or if it's understaffing and driven by the need to hire more workers.
To keep its 24 hour-a-day facilities operating, the county has hired new employees and is still looking for more. The Kane workforce increased from 1,214 in 2015 to 1,235 in 2016 (though 24 did not earn a paycheck in 2016). Currently, the county lists 24 open positions in the Kane system.
Biondo said it’s difficult to attract nurses to Kane jobs. With so many hospitals in the county, many nurses opt to work there and earn more money than at Kane, he said. According to the jobs website Glassdoor, registered nurses in Pittsburgh make an average of $52,720 a year. Last year, registered nurses at the Kane nursing homes earned $37,749 on average before overtime and bonuses are factored in. Including overtime and bonuses, they earned $45,333.
Last year, 210 Kane employees left their jobs for one reason or another. That count includes some part-time workers and people who retired, as well as those who quit or were fired.
Biondo said mandatory overtime for Kane employees in 2016 was “few and far between.” Super Bowl Sunday and a few snow days were the rare occasions when Kane asked its workers to put in extra hours. Rather, he said, a vast majority of the overtime was voluntary and the result of workers covering shifts for those who were sick or on vacation. Because those types of shifts account for much of the overtime, it’s difficult to determine when it makes more sense to hire additional employees.
“You have to make these decisions on the daily basis, on a pay-period basis, on a weekly basis,” Biondo said. “It’s something we look at closely. We make these decisions based on the residents.”
Another factor in Kane’s equation is Allegheny County’s aging population. A 2014 report by the University of Pittsburgh’s University Center for Social and Urban Research showed the number of elderly people is increasing faster than the number of younger people in Allegheny County — at a rate higher than the nation’s. Biondo said he is aware of the trend, but it hasn’t greatly affected Kane yet.
Above all, Kane’s around-the-clock work is the biggest driver of its overtime and spending.
“At the end of the day, someone can’t walk away and say, ‘We can do this tomorrow,’” Biondo said. “The things you’re doing, you can’t say, ‘That can wait.’”