Shereen Siewert/City Pages
CNAs (certified nursing assistants) like Bethlene Skains at Primrose Retirement Community in Wausau not only help care for people’s health, they also handle day-to-day care such as providing meals. But experts say there are fewer people available to fill CNA positions, a problem that is only expected to worsen in the years ahead.
Long-term care for the growing elderly population often involves the most intimate aspects of people’s lives. Nursing assistants help patients get dressed, bathe, use the bathroom, and stay healthy. When the elderly can no longer safely live at home, their loved ones rely on long-term caregivers to ensure their health and well-being.
But a May 2016 study shows Wisconsin is suffering from a serious shortage in certified nursing assistants, or CNAs—one that experts say is now at a critical level.
The study, performed by a coalition of Wisconsin’s long-term care advocacy groups, is the largest of its kind ever to be completed. Nearly 700 Wisconsin care facilities were surveyed, with alarming results: About one in seven, or nearly 11,500 caregiver positions statewide, are now vacant, says John Sauer, president and CEO of the statewide senior advocacy group LeadingAge Wisconsin. And those positions aren’t likely to be filled anytime soon. Nearly half of the providers surveyed say they simply don’t have any applicants to fill those roles.
Part of the problem, Sauer says, is that people aren’t applying for certification at the same rate they were even just three years ago. Between 2012 and 2015, the number of people applying for Certified Nursing Assistant certification plummeted by 24%.
Jean Burgener is working on one solution to the caregiver crisis in central Wisconsin: train seniors over 55 to work as CNAs through a partnership with Northcentral Technical College and Pine Crest Nursing Home in Merrill.
“Seniors make great CNAs,” says Burgener, a retired Aspirus administrator who now advocates for new senior programs. “Too many people assume the job involves some kind of heavy lifting, but it doesn’t. It requires patience, kindness and compassion.”
To date, two graduating Senior CNA Academy classes have been held, with scholarships footing the bill for every senior student so far. Another similar program launched late last year in LaCrosse.
Many of the seniors who applied to the program did so because they saw firsthand, through experiences with family members, the need for skilled, empathetic caregivers, Burgener says.
Training seniors as CNAs is great for both the retirees and the residents of long-term care facilities, she says, because the CNAs remain active, employed, and better educated about health care in general. The residents often find themselves more comfortable with someone closer to their own age.
“They find things in common, connections that make a big difference,” Burgener says.
Pay is a factor
But becoming a CNA isn’t for everyone. The job can be difficult and demanding, and the pay is relatively low at many facilities.
The median starting wage for personal caregivers, at $10.75 per hour, is $1.25 less than what non-health care employers are paying for unskilled, entry level workers at gas stations, grocery stores and even some fast food restaurants, Sauer says.
Recruiting and retaining caregivers often hinges on rewarding employees with competitive wages and benefits. But that’s especially challenging in Wisconsin. In 2015, the state ranked second-worst in the nation for Medicaid reimbursement rates for nursing homes. Today, the state ranks dead last, according to federal data. “So much of what we’re able to pay caregivers is dependent on governmental payments,” Sauer says. “Without higher reimbursement rates, providers are unable to invest in the workforce.”
An American Health Care Association study released in May found Wisconsin’s skilled nursing home facilities faced a $53 shortfall for each patient per day when compared to how much they were being reimbursed through Medicaid, the federal-state funded health insurance program administered by the Wisconsin Department of Health Services. The projected cost to a facility for each Medicaid patient day was $221 in Wisconsin, but the state reimbursed just $168 or 76% of that cost.
By contrast, Minnesota increased their average Medicaid reimbursement rate by 23% in the past two years and initiated grants and aggressive apprenticeship programs to attract people to the field.
Wisconsin should do the same, Sauer says, and programs like the one Burgener launched last year will be key to filling crucial positions. “We are going to have to do more to attract people to these positions, and that starts at the legislative level,” Sauer says.
Some facilities aren’t waiting for a legislative change before taking action to improve their workforce. Instead, they’re ramping up recruitment efforts by offering sign-on bonuses, higher starting wages, and tuition reimbursement plans.
One example: Tender Reflections, a retirement community in Weston, recently advertised a $250 signing bonus for CNAs who applied before Dec. 31. Other facilities are offering similar perks.
Mount View Care Center, Marathon County’s nursing home on the North Central Health Care campus, is taking a multi-faceted approach to filling the gap. Starting last fall, Mount View amped up its starting wage for CNAs to $13 per hour, well above the statewide average. Starting salary bumps up to $15 per hour for caregivers with at least one year of experience.
But Sue Matis, a senior member of the Mount View human resources team, says retaining staff involves much more than money. At Mount View, orientation takes nearly two weeks and focuses largely on the organization’s core values. New CNAs are invited to lunch with residents and with members of the executive team, where they exchange ideas and get to know one another on a more personal level. And top executives have regular listening sessions to better understand what’s working and what isn’t at the facility.
“We’re working hard not just to attract good people, but to keep them for the long term,” Matis says.
Another effective way to fill the gap is to beef up youth apprenticeship programs to attract younger people to healthcare careers, Sauer says. The YA program at NTC is a rigorous two-year elective program for CNAs that combines academic and technical instruction with mentored, paid, on-the-job learning. The program has a multitude of benefits for students and employers alike, Sauer says.
High school students who participate in the program can earn a paycheck while learning from skilled professionals, giving them the necessary expertise to improve employability. Employers can access a pipeline of trained employees, often filling critical gaps, especially in the summer months when full-time caregivers schedule vacation time.
“If we’re going to make sure we have enough workers to care for our aging population, we have to start with training our young people through additional youth apprenticeship programs,” Sauer says. “We have great programs now, but we need more. I can’t stress how important this is.”
The gap is only expected to increase as the population ages. Experts project the need for personal care workers to increase by more than 26% by 2022. By taking action now, Wisconsin can avert a more serious problem later, Sauer says.
“When the baby boomers really hit, 20 years from now, the problem will be even more dramatic,” Sauer says. “If we’re in a crisis now, it will be catastrophic if we don’t do something soon.”