A bill that would allow non-certified nurse aides to work in nursing homes longer than four months has been reintroduced in the House of Representatives.
Reps. Brett Guthrie (R-KY) and Madeleine Dean (D-PA) are backing the Building America’s Health Care Workforce Act, which would waive a requirement for temporary nurse aides to complete 75 hours of state-approved training and a competency evaluation in four months. Earlier in the pandemic, a similar waiver provided nursing homes with a new staffing supply after thousands of trained caregivers fled their jobs.
The Centers for Medicare & Medicaid Services allowed the waiver to sunset last summer, forcing TNAs in most states to get certified by October or leave their positions. The agency granted additional waiver extensions to at least 15 states and dozens of individual providers, but in most cases those were tied to the public health emergency.
The new nurse aide waiver legislation would restore the allowance nationally for two years beyond the public health emergency, which is currently slated to end in April.
“Quality care for seniors in nursing homes continues to be threatened by historic workforce losses in nursing homes,” Guthrie said in a statement. “This legislation not only helps strengthen the nursing workforce to ensure seniors have access to safe and quality care, but this also provides an opportunity for workers to further their careers and earn higher wages.”
Better footing second time around?
A similar bill introduced by Guthrie last session garnered 44 co-sponsors but never found its way out of committee for a full vote. This year, however, Guthrie is expected to chair the Energy and Commerce Committe’s health subcommittee, which could give the bill legs. It had 19 co-sponsors at its introduction.
The nation’s two largest nursing home advocacy groups both pressed lawmakers on the TNA issue last summer and fall, fearing the loss of newly recruited workers who had the potential to build long-term careers in the nursing home sector.
LeadingAge in particular had argued for TNA flexibility for an additional 24 months and to have CMS count on-the-job job training toward the 75-hour federal requirement. Spokeswoman Colleen Knudsen on Wednesday praised the House bill’s reintroduction.
“Workforce challenges in nursing homes and other aging services settings continue to limit older adults’ and families’ access to care. Temporary nursing assistants play a critical role in building direct-care staff at a time when nursing homes remain unable to fill open positions,” she said.
“The reality is that providers are looking for workers that currently don’t exist, and the pipeline is shrinking daily. Addressing workforce shortages in long-term care has got to be priority No. 1. We support this bill and hope that members of Congress will as well. This is one of many initiatives that are needed to address shortages and also build a workforce pipeline for the future.”
The American Health Care Association early this year reported that nursing homes lost 210,000 jobs between February 2020 and December 2022, with workforce recovery in 2022 slower than projected. The sector’s workforce is at 1994 levels, but providers have added an average of just 3,700 jobs monthly since last summer.
Some 96% of nursing homes participating in a recent AHCA survey said they were “experiencing difficulty in hiring,” while 45% said their workforce situation had worsened since May 2022. Many of those facilities desperately need nurse aides, whose presence is necessary to meet many state’s staffing minimums and keep doors open.
Lengthy waiver could be lifeline
Among the states granted waivers to keep temporary nurse aides last fall was Pennsylvania, where the state faced major testing backlogs caused by COVID shutdowns and the state testing firm’s inability to hire nurse proctors.
“In the months since the TNA program was extended in Pennsylvania, our providers have seen dramatic improvements in the certification process, but there are still examples of limited availability and lack of options for testing,” Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, said Wednesday. “If the PHE ends this spring, there is a real potential that TNAs will be removed from their post because their certification isn’t complete… A two-year extension of the TNA program would allow nursing home providers more time to better ensure any TNA seeking to become a certified nurse aide could successfully complete the certification process in order to remain on the front lines.”
Co-sponsor Dean also noted that the act “will help TNAs gain more time and firsthand experience in long-term care facilities so they can learn and grow in their careers.”
Consumer groups have protested the lengthening of TNA training periods, arguing that it endangers patient safety, and that was a stance CMS took in ending a broad waiver.
The new nurse aide waiver bill’s sponsors said this week that the bill includes safeguards including competency evaluations that assess temporary nurse aides on a variety of factors, such basic nursing, personal care and interpersonal skills; and mental health and social service needs. They said it also would improve continuity of care for residents, rather than forcing nursing homes to hire and rehire for the same roles if certification is not immediately attainable.