caregiver with resident
(Credit: Getty Images)

The federal government must take permanent action to address the long-term care workforce shortage as providers brace themselves for severe consequences following the end of the temporary nurse aide waiver this week. 

“The long-term care workforce crisis has never been more dire, and now is not the time to let crucial supports and flexibilities end,” said Holly Harmon, RN, senior vice president of quality, regulatory & clinical services for the American Health Care Association/National Center for Assisted Living. 

“This is especially true for the heroic temporary nurse aides who stepped up to serve our vulnerable seniors during this pandemic and are hoping to build a career in long-term care,” she added. 

Tight deadline 

The Centers for Medicare & Medicaid Services first announced in an April 7 memo that it was eliminating 16 COVID-related waivers, some sunsetting 30 days after issuance of the memo and some in 60 days. The first set of COVID waivers ended on May 7 and the final set, including the one for temporary nurse aides, will officially be retired Tuesday.

The aide policy has allowed facilities to employ the non-yet-certified assistants for more than four months, even if they haven’t completed the necessary training and certification requirements.

The original four-month deadline will be back in place if nothing else is done before Tuesday.

Harmon said that providers are concerned that states do not have sufficient capacity to accommodate the training and testing needs for hundreds of thousands of temporary nurse aides in a four-month timeframe. 

In fact, the April 7 memo acknowledged state capacity concerns and potential delays if some states can’t handle the volume of individuals who need the required training and testing in time. CMS has said in the case of states’ shortcomings, providers and nurse aides may show documentation of the delays and their attempts to complete the requirements. 

LeadingAge said it’s been trying to work with CMS to get clarification on the specific documentation needed to demonstrate good-faith efforts amid challenges due to limited capacity. 

“To date, we do not have any more information,” a LeadingAge spokeswoman told McKnight’s Long-Term Care News Friday. 

A survey of 60 skilled nursing and seniors housing executives by the National Investment Center for Seniors Housing & Care found that 58% of respondents believe the waiver’s expiration will have a moderate impact on their organization’s ability to staff their facilities. Another 17% reported it would have a strong impact, while 25% believe it will have a minimal impact on staffing.

“The timing on this is concerning,” the LeadingAge spokeswoman said. “Though the waiver will end, workforce challenges will not. And there is no current plan in place to help nursing homes with staffing. Consider that over 10 million jobs are now open in the service economy – but the US workforce is not looking for service jobs.” 

Help on the way

Both AHCA and LeadingAge have applauded legislation (HR 7744), which would extend operating flexibilities on temporary nurse aide certification requirements for 24 months after the public health emergency ends. It also would allow temporary nurse aides to continue working in the role and apply their on-the-job experience toward the 75-hour federal training requirement to become a certified nursing assistant.

“Without further action by Congress, hundreds of thousands of individuals are at risk of losing their jobs, and residents will lose the caregivers they have come to rely on,” Harmon told McKnight’s on Friday. “We need lawmaker support to build a stronger, more stable long-term care workforce.” 

Rick Abrams, CEO of the Wisconsin Health Care Association/Wisconsin Center for Assisted Living, is banking, albeit cautiously, on Congress to offer some relief through HR 7744. Otherwise, he fears the state’s caregiving crisis will only deepen.

“The sunset of the waiver could not happen at a worse time,” said Abrams, adding that an infusion of $6 million into a state training program could finally start making headway into the state’s 30% CNA vacancy rate. But even if workers enroll in the program now, they may not be fully certified by the time the waiver ends.

“Quite frankly, four months is not a lot of time,” he recently told McKnight’s. “Hopefully, we can get everybody through the pipeline. But the truth is we can’t afford to lose one person.” 

LeadingAge added that a lot must happen before HR 7744 could become law. 

“We cannot lose sight of the context here,” the spokeswoman said. “Which is why an all-of-government approach to addressing nationwide staffing challenges is needed.”