Heatlhcare Staffing Crisis (Long Term Care)
KWCH TV had story about the dire need for staffing in Long Term Care communities to the point several are to the point of closing. I took to our Facebook page and asked our followers for their thoughts on the matter. So many were quick to respond, with over 130 comments in just a few days, I saw a few common threads that were in almost every reply, below are some representative replies. I should say that I did hear a few comments regarding vaccine mandates, but they were less than I had expected.
1.) Pay – The pay does not equal the work. Why would I go back to LTC, when I am now working at _____ for $17/hr?
2.) Admin and Some Nurses – “Management and some nurses are rude, do not listen or care and do not help when you are short and overwhelmed, they treat you like a sub-human.” “There are much better jobs out there that pay more and treat you better. You have no voice; they just want to work you like a dog and fire you the first time you need to call in or something goes wrong.” “If I am sick, they want me to come in so they can ‘check’ me, but they take off all the time for their kids ball games and everything else”.
3.) Mental health – “Being a CNA is hard on your body and hard on your heart.” You care for these people and then they pass away and it hurts”. “The hours of working short, covering shifts, staying late”. “It is difficult to have a life when you work as a CNA”.
This is a raw stinging rebuke of our LTC community at large. I have spoken with and been on the management side myself and I know there are counter stories but today, I want to focus on this issue of how to stop the mass exodus of CNA and CMAs and how to attract them back and find and retain new staff.
I asked what would make you come back to LTC, the answers ranged from, “if they pay me $20/hr because that is what the job is worth”, to “I will never go back because they will never change”.
I reached out to several that gave quick answers to see if they would talk more in depth with me, a few did and their candor and insight was very helpful in achieving a deeper understanding.
They feel that they do not matter to management, very little engagement, input, and encouragement. Many state that the only time they see management is if they are in trouble. They feel as though they are expected to work and care for the residents when no one cares for them. There is a mistrust that is visceral. They are trying to balance childcare, living expenses and so many issues without support. One CNA told me that she was trying to deal with her car being broke down and had to find rides to work and her daycare provider was ill and she was over her head in bills and was distraught and asked to take a day off to try to get things in order and was told that if she did not show up for her shift then she would lose her job. She said she understood that the residents needed her there, but she also needed to take care of her life as well and wished they could just understand that. One CNA actually told me “now they need us more than we need them, it feels good to finally have the tables turned, I want more for my life and I deserve it.”
So how is a LTC community that is financially strapped and struggling to find staff for all departments handle this crisis? I think it starts with a good look at your culture. Culture is so important. It is more than just posters on the wall with mission statements or a hero work here banner. It is deep and endemic; it is personal and cannot be confined to stiff policies. It is showing respect and teamwork for the entire company from the top down. There are countless books and podcast about this and I will leave that to the experts for communities to seek out.
Another point is the obvious, pay. For years the pay for a CNA was nearly stagnant at as low as $9 to around $12 an hour. This is not even remotely a living wage. I agree the value of a good CNA is significantly higher. A year ago I was a proponent of a $15/hr wage for CNAs, but now that is clearly not enough in light of the rising wages of all other jobs. I am aware that the Medicaid reimbursement rate is hideously low and that rising wages will make the price of LTC go up to the point it is unaffordable to most people, but the simple truth is that you will not be able to find people to work for that wage any longer. Those days are gone forever. If you have agency in your building then you already pay more, would it be better to pay more and have your own staff?
Paying for their education. Becoming a CNA/CMA costs money. I know Allied has not raised their tuition in years and really needs to do so but we have not done so because of the loss of the big KHPOP grant which paid for thousands of CNA/CMA and other healthcare workers is gone. Coming up with $669 is very difficult for so many that otherwise might be interested. Nursing homes are required to reimburse new CNAs for their tuition, but if a student cannot afford the $669 in the first place then it is irrelevant. Several LTC communities tell me that they have been burnt by paying for a student that took the course but then quit before they even worked a week. LTC communities can teach their own CNA course but that takes 90 hours of an RN off the floor and is not sustainable. Allied offers a curriculum hosting option where the LTC only has to teach the skills and the clinical components for a cost of $369 per student or for $500 for teaching all of it and just having the student complete the last 25 hrs of clinicals at the LTC community. We have several communities that do this but I am shocked that so many that dearly need the staff do not participate in this offer. We need funding such as the KHPOP grant restored so that anyone wanting to be a CNA does not have to face the barrier of the price of tuition.
Allied Health Career Training is down on student count as well. The pandemic has shown the difficult work of healthcare workers and with wages higher in other sectors the question remains of why would someone put their own health and that of their family at risk for the low pay and hard work? I think we all need to work together to make the experience and concept of being part of the healthcare community viewed in a positive light. I would love to meet and discus ideas with anyone that wants to be a part of the solution.
If we truly want to end this crisis quickly, immigration is the ultimate solution. Seven years ago nearly 30% of our students were immigrants. Legal immigrants take the entry level positions and I saw them study so diligently to pass the state exam. We need good immigration reform. That is the ultimate solution. But it is an election year and there is a nearly zero chance of that happening so it appears that we will have to solve this mess on our own. Who is up to the challenge? Together we can make a difference.
