Recent calls for nursing home reform and the actions of regulators and lawmakers have drawn renewed attention to the role CPNs currently play in nursing homes – and how their role could evolve.
Some skilled nurse operators have responded to calls for expanding the role of CNAs by creating more specialized positions, and some state legislatures are supporting these moves.
Expanding that role also means aligning more closely with value-based care, industry leaders say, as the pandemic and staffing crisis have forced NFCs to think about division of labor from top to bottom. low.
“Ninety percent of nursing home care is provided by CNAs. That means it’s one of the most important roles in a nursing home,” Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (NAHCA), told Skilled Nursing News. “I think if we expanded the role to be more like other settings where CNAs are used, we would see more people take up this career opportunity.”
NAHCA represents more than 26,000 caregivers at more than 500 nursing homes in 49 states.
The recently released report from the National Academies of Sciences, Engineering, and Medicine (NASEM) discusses expanding roles as a critical step toward empowering CNAs as demand for the position increases. Simultaneously, operators are struggling to recruit and retain these workers, and now they face additional pressure as CMS recently announced the expiration of temporary waivers for care aides.
About 420,000 nursing home workers have left the industry since the start of the pandemic, according to the US Bureau of Labor Statistics.
In addition to the expansion of roles, the NASEM authors call for career advancement opportunities and peer mentorship, free initial and ongoing training, coverage of the time needed to complete education programs and training and new models of care that include CNA as part of an interdisciplinary program. team.
“A few states have advanced CNA positions, and I think we’ll see more of them, really trying to create career paths for those who want to advance,” said Katie Smith Sloan, president and CEO of LeadingAge. “We need to professionalize this [role] paying them well, giving them career opportunities… elevating the role they play.
Currently, CNA training is “pretty generic,” Porter said. The organization is working towards a CNA career that provides workers with multiple pathways to advance and gain an education.
Some of these specializations involve training in medical technology or training to become a certified medication aide (CMA). These specialized CNAs have the authorization to issue “med passes” or to distribute drugs to residents.
“The nurses consider pushing the pill cart, as they call it, a punishment. A CNA who becomes a CMA pushes that cart like it’s the American flag,” Porter added.
Another specialization looks at family communication, with a CNA becoming a liaison between the nursing home and the resident’s family.
“CNAs are the experts on families,” Porter said. “Yet institutions never want CNAs to talk to families… trust has been a big issue, a big talking point throughout the pandemic. It’s one of those reasons, one of those things that erodes trust. Don’t talk to investigators. Don’t talk to mediators. Don’t talk to families. Well why not? This is where we get our recognition.
Every role at Tabitha Health Senior Care has changed due to the pandemic, according to Christie Hinrichs, president and CEO of Tabitha. The CNAs, for their part, took on the role of connector and companion when families were unable to enter the building.
Tabitha, a nonprofit operator from Nebraska, added another position called personal care assistant to the list. This position involves assuming responsibility for time-consuming activities that do not require clinical certification.
“There just aren’t enough bodies for us to ever have the same type of workforce that we always had,” Hinrichs said.
Tabitha leaders review each job description and ask themselves what the requirements are for each position and whether the role really requires a certified worker.
Specializations and state legislation
Recent Florida legislation has expanded the positions that count toward minimum staffing requirements – the personal care assistant would be a prime example.
The state currently requires 3.6 hours of direct care per resident per day, but the Florida legislature in March passed a bill that reduced the minimum number of hours of care provided by certified nursing assistants, from 2.5 to 2.0.
The new law allows other health professionals, such as mental health workers and physiotherapists, to help meet the required hours.
According to Florida Health Care Association (FHCA) communications director Kristen Knapp, the bill eases some of the pressures of hiring CPNs when choices are slim, but without sacrificing patient care.
Allison Salopeck, president and CEO of the Jennings Center for Older Adults in Ohio, said she would like to see such legislation in her state.
“I like it in Florida, and we need to be stronger about it,” Salopeck said. “The background and skill level of the people who serve the residents are not all nurses and practical nurses.”
Nursing homes have changed roles and created new positions out of “pure survival”, Salopeck added; she hopes that state and federal entities recognize and welcome the adaptability of the industry.
Another specialization can be obtained through a course offered by the NAHCA, to become a specialist in geriatric care, in which more than 10,000 members have paid to attend. Porter said she would like to see a career path that also connects CNAs to the infection control specialist role. .
Other industry experts also believe that CNAs have more to offer than they have been given the opportunity to contribute.
“When this work was originally conceived, it was relatively narrow, and I think a lot of ANCs across the country can and want to do a lot more,” said David Grabowski, a Harvard University professor and committee member. of NASEM focused on nursing homes. “No one knows the resident better than these people. They could be that bond with the family.
Empowering CNAs also means allowing them to work at the peak of their license, Grabowski added, and potentially having other unlicensed positions created to free up CNAs to provide services that only they can provide.
Operational diagrams and enclave model
One pilot staffing program gaining traction in the nursing home space is the Enclave Principle model, Porter said. In this approach, a CNA department is created, with individuals in this department reporting to the full-time Director of CNAs.
This manager would then report clinically to the Director of Nursing (DON) and operationally to the Administrator. The NAHCA is working to launch the model nationwide, Porter said, with more announcements on the way in a few weeks.
“The enclave [model] has been around, it’s no secret. It will just be our first major player to really make national news with him,” she added. So far, NAHCA has rolled out the model in Michigan, Arizona and Missouri.
The model would expand the role of CNA and empower those in this position, particularly if a facility experiences high turnover in other leadership positions such as trustees and DONs.
“We need to stop fighting leadership to be better and empower people to be great themselves, regardless of the leader. That’s what the enclave model does, creates a separate department of CNA-led CNA,” Porter said.
Such a model adds to a CNA’s career paths and encourages higher education without locking a CNA into RN or LPN training.
Historically, the nursing home workforce has been very hierarchical, Grabowski said. Members of the NASEM committee discussed at length how to make the CNA role a long-term position.
“There hasn’t been a lot of investment or empowerment of direct care workers. I think the idea here was to try to reinvent not just the CNAs, but all of these roles,” he added. “Let’s not make it a job that someone does as a last resort, but rather something someone invests in and can use…as a career ladder to a wider set of positions.”