Long before the COVID-19 pandemic emerged, certified nursing aides (CNAs) were in short supply across the United States. Now, it has deepened with the onset of COVID-19 to crisis levels as staffing shortages are colliding with a huge increase in patients. The reality is a large percentage of CNAs work in nursing homes or other long-term care facilities where they are on the front lines of caring for the most vulnerable. This presents a range of challenges – some new and some old – for facilities in dire need of CNAs.
Why Such a Challenging Environment?
While much has been said and written regarding the challenges of front line workers during this pandemic, less scrutiny has been paid to CNAs and other home health aides – who collectively represent the largest category of healthcare workers in the country – nearly 5 million people working across a range of facilities and homes. These workers at the forefront of the COVID-19 crisis have long been underpaid, overworked, and under-resourced.
During the pandemic, they are facing an even more stressful and high-risk environment. These valuable workers find themselves on their feet for long hours and dealing with human tragedy daily. Meanwhile, advocates for frontline workers say nursing aides are in particular jeopardy if infected with COVID-19, in part because they were not included in the provision of the federal CARES Act that provides paid sick time for many employees.
The situation is urgent as CNAs are needed to boost current staffing, particularly at long-term care facilities where COVID-19 outbreaks have been severe nationwide.
The pandemic exacerbates the longstanding issue of a lack of competitive pay rates for CNAs. Even in hospitals, where wages are higher and full-time employment is the norm, CNAs are typically paid less than $15 an hour. Coupled with pay rates is the added challenge of shift restrictions currently placed by hospitals, acute care facilities and SNFs that limit the ability of CNAs to pick up per diem shifts outside of their home facilities to avoid potential cross contamination and infection risks. This limitation prevents many per diem workers from picking up shifts to supplement their income – adding to their financial burden.
These challenges combine to give some workers in the market little incentive to return to CNA work as collecting unemployment may be more financially advantageous. This reality has many CNAs facing a heart-wrenching decision given their desire to provide care to those in need amid the need to protect their wellbeing and livelihood.
As the infrastructure that usually provides care for kids (schools and day cares) have largely closed, many CNAs are facing an impossible choice between caring for victims of a pandemic and caring for their own children at home. Even alternative options such as, finding babysitters or others to care for their children, presents challenges given the need to social distance. And when the kids who need caring for live with a healthcare worker, one of the homes in the equation is at a higher risk of exposure to COVID-19. The result is a reduction in this key workforce at the greatest time of need to protect patients and the public.
The Appeal of CNA Assignments.
The difficulty in finding qualified CNAs in today’s environment stems largely from the existing underinvestment in these workers, making it harder to respond now. Today, it can be extremely challenging to attract CNAs to particular facilities, such as nursing homes or long-term care facilities, with an ongoing outbreak.
Although Life Care Center was the first nursing home in the U.S. to experience a COVID-19 outbreak, it is certainly not alone. More and more reports are emerging of outbreaks in nursing homes across the country. And, given the risk of infection is often greater outside hospitals – at long-term care facilities – these jobs are hard to fill. This comes as nursing homes already faced notoriously high staff turnover rates and difficulties attracting staff because of low salaries and a demanding work environment.
As many long-term care facilities turn to temporary assignments to meet staffing demands, this too can be an arduous task. For many CNAs, short term assignments feel less desirable given the heightened risk of returning to work during a pandemic, opting instead for longer-term assignments or permanent employment.
How Do We Bring Back CNAs?
CNAs are the backbone of patient care in many healthcare facilities. While the nurses make judgment calls and interventions in patient care, CNAs serve as the eyes and ears for the nurses and communicate changes in the patient/resident’s condition immediately to the nurse as hands-on support. Their work is physical and often demands a lot of energy. For the communities they serve, they are essential.
In an unprecedented environment, healthcare facilities will need to consider unique strategies to secure their much-needed CNA talent. For example, facility administrators should take into account factors that may put them at a disadvantage in CNA recruitment, such as their geographic location and facility type. In locations that may be considered a hotbed of the COVID-19 outbreak, or at higher risk long-term care facilities, competitive pay rates and the term of assignments can make the difference in luring more CNAs to open jobs.
Here are some questions that can help facilities should close the gap on critical CNA talent:
What geographic limitations does your facility have in place that prevent you from being competitive?
A good assessment of your market and the competitor landscape can help your facility determine where your gaps are and help you determine where the talent is and isn’t within your market. This is where a great recruitment partner can help with market expertise. For facilities in high demand markets like New York, Boston, Chicago and Los Angeles facilities may need to be creative in approach while markets experiencing less demand like Atlanta, greater Cleveland and Dallas may have greater pools of talent.
What financial limitations does your facility have in place that prevent you from being competitive?
While most facilities are feeling the sting of this crisis financially and otherwise, it can be helpful to assess your rates and determine if they are competitive. Considering how your facility may be uniquely positioned to provide critical learning experience to candidates evaluating a career in nursing. For nursing facilities, where pay rates may trend a bit lower than hospital or government CNA assignments, understanding your value and expressing it to your talent pool will be critical.
How is your facility planning to address the change in the CNA landscape?
You aren’t alone in this discussion. As we partner with clients to explore resource pools, conduct market analysis and consult on ways to help facilities close the gap, we welcome the opportunity to partner with you to help identify the challenges and deliver critical CNAs to your facility. For assistance in staffing or hiring CNAs for your organization – contact us today.