The Health Care and Social Assistance industry in Kansas has experienced a continuous upward trend in employment over the last five years, adding 13,449 employees to the labor force between 2010 and 2015. Employment levels in the Kansas City MO-KS, Wichita, Topeka, and Lawrence Metropolitan Statistical Areas (MSAs) also increased over the same period.
Kansas has recently experienced some unexpected shifts in employment levels within the Social Assistance sector and the Nursing and Residential Care Facilities sector. The Center for Economic Development and Business Research decided to explore recent employment trends in these sectors and the impact they had on the overall Health Care and Social Assistance industry.
Note: Data are suppressed for the Wichita MSA for the years 2011 and 2012. Data are suppressed for the Manhattan MSA.
After years of moderate growth, the Kansas Social Assistance sector experienced accelerated growth in employment in 2013 and 2015 growing 9.9 percent and 14.4 percent, respectively. The sector added 6,983 employees between 2012 and 2015 in Kansas.
In the past decade, the Nursing and Residential Care sector experienced moderate employment growth, increasing by 3,844 employees from 2005 to 2014. However, employment declined 0.9 percent in 2014 compared to the previous year, going from 41,032 employees in 2014 to 40,645 employees in 2015.
Social Assistance Sector
Over the past decade, the Social Assistance employment growth in Kansas was largely driven by the Individual and Family Services sub-sector. The trends in Kansas were similar to other geographies, because they were primarily driven by changes in federal funding.
The Kansas Social Assistance sector benefited from employment growth from the Individual and Family Services sub-sector, which grew from 14,446 employees in 2012 to 21,289 employees in 2015.
An increase in the number of employees providing services to the elderly and disabled populations, led to employment growth in the Individual and Family Services sub-sector. Between 2011 and 2015, the service providers for the elderly and disabled increased their workforce by 6,707 employees. Most of this employment growth happened in 2013 and 2015 when employment jumped 34.6 percent and 30.7 percent, respectively.
This employment growth was affected by some provisions of the Patient Protection and Affordable Care Act (PPACA) that took effect in 2013 and 2015. The PPACA, signed in 2010, expanded healthcare coverage to young adults with disabilities:
- Under the PPACA, those young adults can stay on their parent’s health insurance coverage until they become 26 years old.
- Under the PPACA, the Money Follows the Person (MFP) program provides assistance so states can rebalance their care systems by relocating individuals with disabilities from institutional-based settings (e.g. skilled nursing care facilities) to community-based environments. The MFP was extended to more states, including Kansas, by providing them with an extra $2.3 billion in funding.1
As those provisions took effect, federal funding to the state of Kansas increased, allowing for additional hiring.
There were other drivers that resulted in an increase in the elderly and disabled services employment in Kansas. The aging of the population has been a driver in the increase of employment in this sector. As the population ages, the demand for elderly care and disability services rises. The population aged 65 years and over rose by 32,251 between 2011 and 2015.2 The aging of the Kansas population is likely to persist. CEDBR’s Kansas Population Projections (2014-2064) estimates that the state’s 65-and-older population is expected to grow at a considerably faster rate than the population as a whole, expanding from 415,823 to 856,389.
Furthermore, employment growth in the Individual and Family Services sub-sector was affected by an increase in the children and youth services employment. Between 2011 and 2015, child and youth services operators increased their workforce by 1,000 employees; however, the number of child and youth services operators only increased by two establishments during the same time period. A growing workforce in the child and youth services segment is correlated to the number of children living below poverty. As the number of children living below poverty rises, more employees are needed to meet an increased demand. There was an increase of 6,721 children under 18 years-old living below poverty in Kansas between 2011 and 2015.3
Nursing and Residential Care Facilities Sector
Over the past decade, the Nursing and Residential Care Facilities employment growth was largely driven by the skilled nursing care facilities and the continued care retirement communities and assisted living facilities. The trends in Kansas for these two sub-sectors have been similar to the national trends.
The Nursing and Residential Care Facilities sector employment largely depends on employment in the skilled Nursing Care Facilities sub-sector since 54 percent of the sector’s labor force was working in those facilities, on average, in the past decade. Employment in Kansas Nursing Care Facilities began declining in 2012, losing 854 employees between 2012 and 2015. This employment trend is correlated to Medicaid and Medicare. These two programs generate nearly 75 percent of skilled nursing care facilities’ revenue. Medicaid and Medicare payments and reimbursements in Kansas considerably shrunk in recent years due to reforms and continuing budgetary pressures faced by the state4. In fiscal year 2012, there was a national decline of $3.9 billion (11.1 percent) in Medicare payments to skilled nursing care facilities and other health care segments, such as, ambulatory health care services (e.g. office of physicians), as a result of a corrective proposal issued by the federal government in July 2011.5 The decline in employment persisted the following years:
- Resulting from the 2013 federal sequestration, nursing facilities experienced reduced government support with an additional 2.0 percent cut.
- During fiscal year 2016, as many as 10,000 applications of Medicare-eligible Kansas residents had been pending because of the switch to a new computer system processing application (July 2015) and the transfer of Medicare eligibility processing duties to the Kansas Department of Health and Environment (January 2016). This backlog has affected skilled nursing care facilities and their residents. According 2016 articles from the Kansas Health Institute, some skilled nursing care facilities have provided more than one million of dollars of unpaid care to Medicaid-pending patients. Struggling establishments eventually have reduced staff levels or stopped taking patients in order to survive.
The Nursing and Residential Care Facilities sector employment also depends on the Continued Care Retirement Communities and Assisted Living Facilities sub-sector since nearly 32 percent of the sector’s labor force was working in those communities and facilities, on average, in the past decade. The workforce working in the sub-sector increased by 1,786 from 2012 to 2015, and operators increased by 24 establishments during the same time period.
The declining employment trend in the Skilled Nursing Care Facilities sub-sector has benefited Continued Care Retirement Communities and Assisted Living Facilities, since the latter’s cost is less expensive, especially to the uninsured or the Medicaid-pending patients. Employment growth in the Continued Care Retirement Communities and Assisted Living Facilities sub-sector is also correlated to shifting consumer preferences. In recent years, consumers have been deviating from nursing homes and opting for alternatives, such as, assisted living facilities, community-based services, managed care at home, adult day-care centers or visits to specialists.7
The PPACA of 2010 includes provisions that meet changing consumer preferences by favoring lower-cost alternatives to nursing homes. The Community First Choice’s Medicaid program further assistance assists states through a 6.0 percent increase in federal matching funds, so they can rebalance their long-term care systems by providing alternatives to institutional services, such as, skilled nursing care facilities. The Wichita metropolitan area has seen more activities in this sector in the last five years. According to the Wichita Business Journal, in 2015, various assisted living facilities in the Wichita area had expansion activities. Industry experts expect the segment to continue growing in the next few years. In fact, according to Chris Dennis, CFO of Oxford Senior Living, “Again with the aging population, demand in general is very strong. Ten thousand people turn 65 each day and this trend is projected to continue for the next 10 years as the baby boomers approach retirement age. Senior housing is one of the best performing sectors of real estate investing. This tells me that the ‘market’ says there is still considerable room for growth in our industry.”
For additional insights regarding a specific geography or industry-sector contact CEDBR.
1 IbisWorld, April 2016.
2 American Community Survey Five-Year Estimates.
3 Population under 18 years for whom poverty status is determined, American Community Survey Five-Year Estimates.
4 http://www.khi.org/news/article/large-assisted-living-chain-curtails-medicaid-part, http://www.khi.org/news/article/kansas-medicaid-application-backlog-climbs-again
5 IbisWorld, November 2016.
7 IbisWorld, November 2016.
In November 2016, Wesley Healthcare opened a new 11,000-square-foot ER location at the intersection between 63 road and Rock Road in Derby. The facility has 11 emergency beds, imaging capabilities, and an on-site laboratory. The $10 million medical facility began receiving patients on December 5th, 2016.
Wesley Healthcare is also planning to renovate a portion of its Hillside campus. The $12.5 million renovation project will concentrate on the ninth-floor orthopedic wing. Another renovation project will expand the intensive care unit of the hospital by adding 14 beds. This separate project will cost $7 million. Both projects are scheduled to be completed by 2017.
GraceMed, a Wichita-based health center, is planning to relocate its GraceMed Capitol Family Clinic to a former Dillons store in central Topeka. The following services will be added to the new location: additional primary care providers, dental services, vision services, on-site pharmacy, and behavioral health services. The new location is projected to open in 2018. GraceMed, a Wichita-based health center, is planning to relocate its GraceMed Capitol Family Clinic to a former Dillons store in central Topeka. The following services will be added to the new location: additional primary care providers, dental services, vision services, on-site pharmacy, and behavioral health services. The new location is projected to open in 2018.
On December 31st 2016, Hutchinson Regional Medical Center announced a $23 million expansion project of its intensive care unit. The hospital started construction on the new 15,000-square-foot unit in January 2017. The facility will contain 18 beds, larger rooms, and new equipment. Construction is expected to be completed by December 2018. The hospital is also planning a $5 million project to upgrade its electrical and mechanical grids which will start in July 2017.