Instructor shortages and regulatory hurdles are creating training logjams for certified nursing assistants as nursing homes struggle to find enough of them to meet increased demand.
The Centers for Medicare and Medicaid Services requires nursing assistants to receive at least 75 hours of training for certification. Those workers are vital to nursing homes because they provide most of the hands-on patient care and are at the heart of a proposed federal staffing mandate.
Related: CMS' proposed nursing home staffing mandate explained
That controversial proposal would require nursing homes to provide three hours of care per resident, per day with nursing assistants accounting for 2.45 of those hours. The industry would need to add more than 76,000 of those jobs to comply, according to LeadingAge, which represents nonprofit nursing homes.
But training and onboarding CNAs has been complicated in part by a shortage of registered nurses required to teach certification classes. The training must be provided by an RN who has a minimum of two years of clinical experience, one of which must be in long-term care. Finding people who meet those requirements has become more challenging in the wake of a nursing shortage, according to some community colleges and technical schools.
The problem can be especially acute in rural areas with fewer healthcare professionals.
Rural Minnesota is having trouble finding instructors, despite the state investing more than $7 million over the past three years to train 15,000 certified nursing assistants for free. While 2,300 CNAs have been trained so far under the grant, several hundred people are on waitlists for classes due to the instructor shortage, said Valerie Defor who heads the Minnesota State HealthForce Center of Excellence at Minnesota State University and Colleges, which collaborates with the healthcare industry on job training.
She said pay is part of the problem.
“These are not often full-time jobs within education,” said Defor. “When there are other attractive jobs that could be full-time or pay more or have better benefits, that can make it harder to recruit instructors.”
Black Hawk College in Moline, Illinois, also has difficulty finding qualified adjunct instructors if it doesn’t have enough faculty to support students enrolled in its CNA program, according to a spokesperson.
The waitlists are frustrating for nursing homes that need staff now. St. Francis Health Services of Morris is looking to hire 70 nursing assistants for its 14 nursing homes in Minnesota, according to regional director Christine Bakke. She said the shortage of those workers is limiting patient admissions at some of the organization's facilities.
Many larger nursing homes operators, such as Good Samaritan Society, operate their own CNA certification programs. But federal regulations prohibit nursing homes from operating such training programs for two years if CMS cites them for deficiencies during annual surveys and assess fines over $10,000. That has added to the bottleneck, according to providers including Good Samaritan.
The Sioux Falls, South Dakota-based nonprofit, which owns approximately 80 nursing homes in seven states, began offering training three years ago. To avoid students getting locked out of classes at individual locations, Good Samaritan consolidated classroom training at a corporate site that students can access virtually. However, if a student works at a location that has been cited for a deficiency, that student might have to travel to a different location for the clinical aspect of their training.
“It is counterintuitive in my mind to have a punitive process in place to penalize a location that is trying to provide care,” said Good Samaritan Society President and CEO Nate Schema.
Schema said he has been working with the American Health Care Association, a nursing home trade group, to change the rule. LeadingAge has also advocated changing the rule.
Last year legislation was introduced in both houses of Congress that would lift the so-called lockout rule if nursing homes corrected deficiencies for which they were cited and paid fines. Schema said the legislation would be a step in the right direction at a time when CMS wants to mandate staffing minimums for the industry.
