Inside the race to certify temporary care aides as the end of the waiver nears

The Centers for Medicare & Medicaid Services temporary nurse aide waiver will end early next month, leaving nursing homes just four months from the June 7 date to train and certify thousands of temporary workers – or risk losing them.

TNAs hired after June 7 will have four months from their hire date to meet testing requirements, CMS said.

Some operators, like PruittHealth, will look to move their TNAs into non-clinical roles as they progress through training and certification.

“I’m concerned that everyone is getting certified on time, but we’re doing everything we can,” Neil Pruitt, CEO and president of PruittHealth, told Skilled Nursing News. “We hope to find ways to place these workers and we intend to move them to other non-clinical roles until we can enroll them in courses. We do not refuse anyone. »

Others, like SavaSeniorCare, plan to get as many TNAs through certification and testing as possible before the deadline.

“In North Carolina we have a training program where we have an instructor, it’s one of our employees who tries to get as many people into this program and certified [as possible]said Annaliese Impink, executive vice president of compliance, ethics and customer experience for SavaSeniorCare.

Nurses must complete a state-approved nursing aide competency assessment program to become a certified nurse aide with a curriculum that typically includes training in resident rights compliance, basic nursing skills, personal care skills and care for residents with cognitive impairment.

Nurses must also pass a written or oral exam to demonstrate the skills they have acquired.

Disappointed to see the program end, Pruitt wished CMS had aimed to end the waiver once the staffing crisis eased.

“Our critics want us to staff the buildings and that’s a good way to do it and unfortunately they’re taking one of our tools away from us so I’m very disappointed with that,” he said.

Test delays could be a factor

CMS cited the results of a long-term care survey that linked residents’ weight loss, depression and pressure ulcers to “lack of certain minimum standards” as one of the reasons why the waiver was coming to an end, according to a memo released by the agency.

Yet the program has proven essential in attracting new employees to the sector. In Michigan alone, the waiver brought more than 2,000 workers into the long-term care sector as temporary aides.

Ray Thivierge, chief strategy officer of SavaSeniorCare, believes the waiver program has attracted more frontline staff who otherwise might not have joined the industry, as it allowed them to “get started” in the provision of care.

“Overall, I think we expected it [to end] and to some extent we have planned for it and prepared for it, but the timing just adds more fuel and more challenges when we are already facing staffing issues,” said Thivierge told SNN.

Impink thinks the biggest time crunch will be getting everyone tested on time, as many states, including Texas, are currently behind schedule and don’t have enough instructors to meet the number of candidates ready to test. .

Holly Harmon, senior vice president of quality, regulatory and clinical services for the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), was concerned that the short time frame for everyone to be certified and tested would not a challenge for operators.

“Our concern is that the state’s capacity is not sufficient to meet the training and testing needs of thousands of temporary nurses in this short period of time,” she said.

Harmon doesn’t think now is the time to leave such crucial flexibility to nursing homes amid a historic labor shortage.

“We call on Congress to take action by granting a reasonable grace period to allow TNAs to move into long-term roles,” she said.

PruittHealth, for example, currently employs 277 TNAs, 192 of whom are actively enrolled in a health care aide training program. While the other 85 are seeking a training program, the Georgia-based retirement home operator is currently unable to enroll them due to capacity issues, according to Pruitt.

“We are aware that there may be instances where the volume of aid who must complete an approved state [program] exceed the capacity available to enrollees in a training program or to take the exam,” CMS wrote in the memo announcing the end of the waiver. “This can lead to delays in the certification of nursing aides.”

CMS said if a facility or nurse aide has documentation showing their attempts to complete the training or testing, they can continue to work at the facility while working to become certified as soon as possible.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (NAHCA) — an organization that supported the end of the waiver when it was announced last month — told SNN there was already a shortage of places to certify CNAs before the last decision of the CMS.

Trying to train everyone in time will likely make the problem worse, she said.

“There’s nowhere to send [CNAs] to get them certified, especially if you’re in a rural area,” Porter said. “There is a nationwide shortage of nurse educators, even in nursing schools.”

Around 420,000 nursing home workers have left the industry since the start of the pandemic, according to data from the US Bureau of Labor Statistics, with nursing homes losing 15.2% of the workforce sector total.

Labor shortages could worsen

CNA turnover has been an issue of particular concern for nursing homes, and the waiver – like other initiatives passed over the past two years – has provided a much-needed infusion of new workers to the sector.

“The waiver was pivotal for us. We’ve had about 989 temporary practical nurses, and about a third of them are still employed with us,” Pruitt said.

Imink said that at the height of the pandemic, the waiver was very beneficial at a time when it was “desperately” needed.

A recent survey of 69 owners and managers of senior living facilities and skilled nursing facilities across the country found that a quarter of respondents had more than 20% of their full-time positions currently vacant, according to data from the National Investment Center for Housing for the Elderly. & Care (NIC).

The Evangelical Lutheran Good Samaritan Society has over 200 TNAs that it strives to have certified.

“We are really grateful for the waivers that have been put in place by the government and regulatory agencies to help us really get through the height and peak of COVID-19, but now that we are seeing some of those waivers being rolled back and start to untie there are new challenges,” said Rochelle Rindels, vice president of nursing and clinical services at Good Samaritan.

Rindels said Good Sam’s partnership with Sanford Health has proven beneficial on this front because it has allowed the nonprofit provider to create an in-house CNA training program to enable TNAs to train on-site.

Of more than 600 students who have completed the Good Samaritan TNA program, the organization has recorded a certification pass rate of 91%.

“We have always wanted to provide training for the position of CNA, recognizing how important it is in our facilities,” Rindels said. “They are the ones who meet the inhabitants on a daily basis. We have several instances where we have had a CNA who obtained their nursing license and then worked as a director of nursing at the same facility.

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