Given their day-to-day, intimate interaction with residents, certified nursing assistants (CNAs) are uniquely positioned to contribute to care planning and interdisciplinary care team (IDT) meetings, where important decisions about residents’ care needs and changes to their care plans are discussed. 

For example, CNAs possess a deep understanding of residents’ needs and preferences, including their favorite meals, music, TV shows, activities, level of comfort with the current care plan, and baseline conditions. 

Yet, CNAs are often excluded from care planning and IDT meetings, impacting the comprehensive and personalized care delivered to residents.

In 2016, the Centers for Medicare & Medicaid Services (CMS) began requiring the integration of CNAs into IDT meetings and resident care planning. While laudable, the lack of clear guidelines on how nursing homes can integrate CNAs in IDT meetings and resident care plans has made implementation of this requirement challenging. 

Barriers to integration

In our ongoing research with CNAs, directors of CNAs, directors of nursing, social workers, nursing home surveyors, ombudsmen and physicians, we found that the challenges nursing homes face in integrating CNAs are complex. 

This includes coordination issues among CNAs across different shifts, not having suitable times for IDT meetings that accommodate CNAs’ schedules, a failure of administrators/executives in acknowledging CNAs’ value, insufficient training for CNAs on care planning, and staffing shortages. Further, members of the IDT also struggle with knowing what questions to ask CNAs and how to leverage their expertise into decision-making during care planning. 

Addressing these issues is crucial for the seamless integration of CNAs into care planning and IDT meetings and the overall improvement of resident care. To facilitate the integration of CNAs into these meetings, nursing home executives can draw on the following strategies based on our findings:

Cultivating a culture of CNA recognition and empowerment:

  1. Have administrators spend time on the floor with residents and CNAs to better understand their contributions. 
  2. Make leadership more approachable and present in the building through open-door policies for all employees. 
  3. Educate CNAs on the care planning process.
  4. Allow CNAs to write in care plans and be involved in electronic documentation, providing them a sense of leadership. 
  5. Create a Director of CNAs or lead CNA role via new hire or promotion.
  6. Incentivize CNAs’ active participation in IDT meetings by providing opportunities for professional growth and/or raises.

Navigating challenges with scheduling IDT meetings:

  1. Conduct polls and surveys among CNAs using free tools like Qualtrics or Google Forms to identify their preferred meeting times for IDT meetings.
  2. Explore the effectiveness of scheduling meetings at times like 3-3:30 p.m. to accommodate both first- and second-shift CNAs.
  3. Ensure the CNA responsible for the specific resident being discussed in the care planning and IDT meetings attends and actively participates in meetings.
  4. Provide CNAs with access to the care plan before meetings for review and to provide input.
  5. Ensure another staff member can fulfill CNA duties when they are in the IDT meeting.
  6. Utilize communication tools such as communication cards or daily logs to ensure real-time information is shared among IDT members and tracked effectively.

Soliciting information from CNAs during IDT meetings using the following questions:

  1. Did anything occur today or in the previous month related to the resident’s treatment or rehabilitation plan that you would like to share?
  2. What is and what is not working well in the care plan?
  3. What are the preferences of the resident that are currently not taken into account?
  4. What are your thoughts on the proposed goals of care and implementation strategy in the care plan?

By implementing these strategies, nursing homes can ensure CNAs are not only heard but are integral to the care planning process, enhancing the quality of life for residents through more personalized and comprehensive care plans. 

Aasha Raval, MPH, is a health equity researcher at the NYU Rory Meyers College of Nursing, where she is also affiliated with Hartford Institute for Geriatric Nursing.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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