Certified nursing assistants, the workers who help elderly and disabled patients in long-term care with their daily routines, face an emotionally and physically demanding job with pay that hovers at $8 to $15 an hour. These workers are in short supply; finding skilled staff is the biggest problem many health care employers face these days.
Now the Idaho Health Care Association Foundation is trying a new tactic to get more CNAs into jobs at the state’s 80 skilled nursing facilities. It’s using a first-time state grant to help cover training costs, and help facilities pay caregivers while they are in classes. The goal of the program is to get 500 more people trained and into jobs over two years.
“The biggest issue for our nursing homes right now is staffing,” said Robert Vande Merwe, the executive director of the health care association, or IHCA. “Everyone has a shortage.”
CNAs provide care such as bathing, feeding assistance, transporting, taking vital signs, grooming and comforting – all the activities of daily living. To work in Idaho facilities, these caregivers need to be certified, mostly through completing a state-approved program.
John Schulkins, CEO of Canyon West of Cascadia, a skilled nursing facility, employs about 40 CNAs and said he would hire another half-dozen if he could. Schulkin said his facility has to compete for CNAs with a variety of alternatives to skilled nursing, such as home health care, assisted living and hospitals, which drives up wages.
Training is expensive and requires time away from work
Some Idaho CNAs get their training in high school, but most use the state’s community colleges, said Vande Merwe. The difficulty arises when would-be CNAs must take six weeks off work to do the training, said Vande Merwe. A lot of people can’t do that.
“Our target audience is those who are willing to work for $11 an hour in a difficult job,” said Vande Merwe. “You’re not getting a wage while you’re sitting in class, and you have to pay $1,000 for the class.”
The grant, obtained through a fund at the state Department of Health and Welfare, will help long-term care facilities pay a wage to the future CNAs as they complete their coursework, and it will help those CNAs pay for the classes.
The long-term facilities are only paid through the program if the employee stays six months.
“If the facilities want to participate in the grant, they must pay a wage to the student for 120 hours at the community college so they have skin in the game,” Vande Merwe said. “They are taking a risk on the employee, so they have a huge incentive to improve their onboarding, training and retention programs.”
Supporters of the grant program see it as a way to help people gain entry to other health care fields, such as nursing.
“It provides a pipeline to introduce them to other careers in health care,” said Shulkins. “I have had a number of individuals who came in as nursing assistants and discovered themselves and took the next step to become a nurse.”
A tough job
The campaign’s target is people ages 21 to 35.
“It’s physically demanding, and for some people, it’s emotionally demanding to meet the needs of patients who might have significant cognitive problems or memory problems or confusion,” Vande Merwe said. “Some patients are just as sweet as can be, and others can be violent and agitated, and they’re on the front lines. Most of our CNAs really love the elderly or disabled, and that’s why they are doing it.”
The money for the grant comes from fines levied against skilled nursing facilities for lack of regulatory compliance, and the grant is administered by the state Department of Health and Welfare, or DHW. Chris Smith, a DHW spokesman, said the department’s research has found that many regulatory infractions stem from a shortage of staff to care for the people at the facilities.
Through Idaho’s cost-based Medicaid reimbursement system, Medicaid reimburses skilled nursing facilities for some of their costs, including what they spend on wages and the student’s CNA course, said Vande Merwe. The IHCA Foundation money will be used to pay the costs that aren’t picked up by Medicaid.
Vande Merwe estimated there are about 1,600 CNAs working in skilled nursing facilities statewide. He added that the College of Western Idaho has started a CNA training program for people who use English as a second language, and provides extra English classes for those who need it.
“Most are refugees, and they’re not afraid of hard work,” he said. “They just need an opportunity.”
Where the grant money comes from
When the federal government levies a fine against a nursing home for regulatory non-compliance, that money goes into a fund
at the state Department of Health and Welfare. The Idaho Health Care Association Foundation is using a grant from that fund, called the Civil Monetary Penalty fund, for its CNA recruitment and training program.
The IHCA’s $500,000 grant award was determined by the federal Centers for Medicaid and Medicare Services after DHW reviewed the foundation’s application, said Chris Smith, a spokesman for DHW. The fund can only be used by skilled nursing facilities.
Association executive director Robert Vande Merwe estimated that there are several million dollars in the account. Though federal and state officials agreed 20 years ago that the money could also be used to help skilled nursing facilities improve, this is the first year that Idaho Health Care Association Foundation has applied for a grant from the fund, said Vande Merwe, who came up with the idea when the long-term care association in Wisconsin did something similar.
IHCA Foundation is going to use some of the money to hire a part-time administrator to run and track the new program and to recruit participants through social media, Vande Merwe said.