A simple change to the way states administer their certified nurse aide exams could easily open the doors to hundreds of new job candidates, providers said as Massachusetts leaders took action.

Gov. Maura Healy (D) last week approved options for CNA candidates to take their written tests in Spanish or Chinese by next year. Nursing home executives and industry advocates cheered the change, calling it a win for immigrant CNAs and residents who speak other languages.

“Just before the pandemic, we turned away probably three dozen applicants that wanted to become nurse aides because we knew they couldn’t pass the test in English, so this is going to be a huge help for us, and I think it’s going to benefit other populations, as well,” Bill Graves, president and CEO of the South Cove Manor in Quincy, told MassLive this week.

South Cove was founded in 1985 to help serve a growing population of Asian seniors that faced significant language and cultural barriers in traditional care facilities. Today, most residents still speak Chinese.

“We could hire another dozen [CNAs] tomorrow and put them to work right away if they could pass the test,” Graves added.

Advocates said the written exam being offered only in English has likely prevented hundreds of non-native speakers from going to work in nursing homes. Trained nurse aides who had worked in healthcare before coming to the US could pass the clinical portion of the test, conducted orally, but often failed the written portion.

As in many states, Massachusetts contracts with an exam-proctoring firm to develop and conduct the nurse aide exams. D&S Diversified Technologies will work with state health officials to oversee language changes.

The NNAAP exam, administered by the National Council of State Boards of Nursing, is another test used in 13 states, Washington, DC, and several US territories. It offers an oral portion in English and Spanish, though it’s unclear how many states allow that option.

An attempt to reach that testing firm for more details Wednesday was unsuccessful.

During the pandemic, some exam boards came under fire for extensive testing delays, and many nursing home leaders pointed to back-ups as a cause for staffing woes. The inability to get students through tests quickly led, in part, to a Centers for Medicare & Medicaid Services waiver exempting temporary nurse aides from having to pass the CNA test before working with patients. That exemption ended along with the public health emergency.

The idea that multicultural testing could now provide a new avenue for recruitment, with the changes coming quickly, came as welcome news to many this week. 

The CNA exam changes were included in the state’s 2024 budget, with an Oct. 1 implementation deadline. State Sen. John Keenan (D) said he hoped to see them in effect before that. The Department of Health could also expand the test to additional languages, MassLive reported.

“The demand is immediate — it’s now, and I think we have to respond as quickly as possible,” Keenan told local media. “It’s long overdue. I can’t imagine how isolating it must be when somebody is in a room and unable to communicate with a nurse, CNA or anyone that comes in.”

There were 3,240 vacant CNA positions across the state, according to a July member survey cited by Tara Gregorio, president of the Massachusetts Senior Care Association. She hoped to see the new tests rolled out “as soon as practical” to help get more CNAs in the doors of nursing homes struggling to hire in a hyper-competitive market.

But the multi-language offerings may have limits, one provider group said Wednesday.

“The idea of offering exams in other languages is in good intent. But then the question becomes, how will that individual handle the skills test or even in-person care if a language barrier still exists in predominantly English speaking long-term care communities?” asked Eric Heisler, a spokesman for the Pennsylvania Health Care Association. 

“If we see long-term care communities designed for specific cultures [or] nationalities where a primary language other than English is spoken, then testing to further accommodate caregivers interested in working in that community –– that need a certification and who also speak that language –– will certainly be a great benefit.”