Opinion: It’s time to give nursing home workers the voice they deserve
Thursday starts “CNA week”— the week officially designated to recognize the work of the 75,000 certified nursing assistants in Pennsylvania, the majority of whom work in and provide the bulk of labor hours in nursing homes. If CNA week mirrors the past, there will be balloons, banners, pizza and pastries in nursing homes across Pennsylvania. This year’s messages will no doubt focus on CNAs as health care heroes.
Nearly 70% of deaths from COVID-19 in Pennsylvania have occurred in nursing homes. The pandemic has certainly illuminated the vital role and the risks of CNAs and all the other health care workers. CNAs go to work providing the most intimate of care, in worksites prone to infection, without PPE, and still without adequate COVID testing. It should be clear now more than ever that these truly essential workers need more than tokens of gratitude.
U.S. Sen. Bob Casey, (D-Pa.) at the federal level, and Sen. Maria Collett, (D-Bucks, Montgomery) and Sen. Lindsey Williams, (D-Allegheny) at the state level, have introduced legislation or convened hearings aimed at the safety of workers and seniors and to avoid another situation where nursing home workers don’t even have PPE. While necessary, we also need broader changes. After decades of well-intentioned efforts by policy makers and elected officials rooted in stronger regulations and tougher compliance measures, improvement outcomes are insufficient.
How can we truly honor CNAs this year? This pandemic should be the impetus for new solutions and broader changes. We can start with better staffing, better pay, and a real voice in the re-design of how care is delivered in nursing homes across Pennsylvania.
If you would ask a CNA what they most want, there is no doubt, better staffing would be tops on their list. It is too hard to try to care for 15-30 residents on any given shift. The latest investigative reporting from Spotlight PA highlights the critical need for Pennsylvania to update and improve staffing regulations. Even those in the industry recognize the need for improvements in staffing, but change is stalled by talk about cost and the inability to find the necessary workforce.
When a portion of CNAs make at or less than $15 an hour (the average wage in Pennsylvania in 2019 for a CNA is $15.19), it is no wonder there are workforce shortages. When CNAs try to give care in work sites rooted in a traditional culture of command and control, it is no wonder as to why there is high turnover of this workforce.
To help achieve better pay and staffing, and to help truly change care delivery in nursing homes, CNAs (and other front-line staff) deserve the creation of direct seats at a decision-making table. Rather than tokens and slogans this CNA week, we need unionized and non-unionized CNAs to be formally convened with government and industry and residents, and with a clear mandate for improvement and change in how we provide care in nursing homes.
Prior to this pandemic, I was assisting some unionized CNAs (and other front-line staff) and management in Pennsylvania to change their past relationship and to collaborate on improving quality and safety. They recognized what much research demonstrates — that improvement in health care is best achieved with the collaboration and a voice for front-line staff and management. Yet, the pandemic shows that we must move faster and more broadly than a few nursing homes at time.
If given a seat at the table, CNAs from the front lines can help re-design a system for better and safer care, to create the standards for improved staffing, and to actually reduce costs to shore up resources so that they are paid a just wage. The true way to honor the heroic work of CNAs is to create a formal setting where CNAs have an equal voice with industry leaders, government and consumers as how to best improve the over 400 nursing homes across our commonwealth.