The Biden-Harris Administration’s recent initiative to establish federal staffing standards in nursing homes marks a commendable step toward improving patient care. These standards, aiming to enhance staffing levels and improve patient safety, are a positive step in the right direction. 

However, creating a safer nursing home environment with appropriate patient-to-staff ratios begins with removing barriers to entry and making the healthcare setting an enticing place to work. The research is well established that greater work satisfaction among nurses directly translates to better patient care. It’s time to invest in infrastructure and regulatory upgrades to improve healthcare provider and patient wellbeing.

President Biden’s initiative should serve as a launch point for broader, holistic healthcare reform that extends beyond staffing minimums and compliance to create an environment that truly supports both staff and patients nationwide.  

Certified nursing assistants (CNAs), the backbone of nursing home care, face considerable hurdles in their professional journey. These workers, predominantly women and people of color, face several barriers, including mandatory training programs, expensive medical testing and repetitive background checks. 

According to the Bureau of Labor and Statistics, CNAs earn a median hourly rate of $17.18, but there are certainly other comparable jobs (e.g., Target or Amazon) that don’t require complicated multi-state onboarding processes. One way to improve satisfaction would be to simplify the credentialing process for frontline workers. 

There are nearly 1.5 million CNAs in the United States who are tasked with meeting the needs of the growing aging population in nursing homes. Care facilities rely on metrics like “hours per patient day” (HPPD) to gauge staffing requirements. In 2001, expert panels recommended a minimum of 4.55 HPPD for optimal safety and care quality in long-term care and skilled nursing facilities, designating 2.8 HPPD specifically for CNAs. Unfortunately, the CNA workforce shortage prevents states from meeting this standard, as minimum staffing requirements can’t be met without a sufficient number of qualified staff.

Three key areas for improvement should be considered under the new guidelines to maximize the availability of workers nationwide.

1. Simplify cross-state regulation — require all states to recognize the CNA Compact

The fragmented nature of state-specific healthcare provider licensure regulations compounds the nursing home staffing shortage. In the tri-state area of Virginia, Maryland and Washington, D.C., data show that more than 330,000 nursing home shifts go unfilled each year because of state-specific regulations that prevent CNAs from working across state lines. This equates to an astounding 2.5 million hours of much-needed patient care that are lost each year.

By prioritizing the human side of healthcare alongside addressing regulatory inefficiencies and promoting a 100% state participation compact for CNAs, we can build a resilient and thriving healthcare system that benefits both its workforce and those under their care.

2. Standardize and speed access to state background checks 

The current regulatory framework demands a reevaluation of the background check process. Currently, healthcare facilities individually enlist third-party background check vendors, leading to a lack of standardization and prolonged timelines, often spanning weeks or months. This is largely due to the intermittent unavailability of state background check repositories because of delays or system maintenance. 

This inefficiency creates obstacles in the hiring and staffing process, which could be alleviated through the implementation of a universal background check system. This system, coupled with nationally certified platforms for CNA licenses, would not only streamline the hiring process but also uphold the highest standards of care in nursing homes nationwide.

3. Eliminate the need for two-step TB testing simplify or move towards risk factors testing

In 2019, the CDC and the National Tuberculosis Controllers Association issued new recommendations for TB testing, highlighting the low risk of infection for U.S. healthcare personnel. 

Despite this, most facilities still require two-step testing upon hire, serving as a significant barrier for workers due to limited availability and non-coverage by many health insurance providers. Serial testing, both costly for facilities and a hindrance for workers, adds to the challenges of entering the healthcare workforce. Several months can pass before a CNA can begin working in a nursing home.

A pragmatic and comprehensive strategy is essential to bridge the gap in healthcare workforce staffing. The president’s efforts to bring attention to this serious matter underscore the need for proactive measures. As we advocate for ratios and quality care, we must also address the barriers to the job itself.  This is the path to higher engagement, satisfaction and better patient outcomes.

Todd Walrath is the CEO of ShiftMed.

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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