Turnover among certified nursing assistants at long-term care facilities will be a top priority for the Centers for Medicare & Medicaid Services going forward, a top agency official pledged Tuesday. 

“Turnover is something that I really think we really are going to now be able to focus on and turn our attention to a lot more in the future,” said Evan Shulman, director of the Division of Nursing Homes at CMS on Tuesday. 

Shulman’s comments came during a CNA staffing summit hosted by the National Association of Health Care Assistants. Experts explored how to address and solve CNA staffing challenges within the industry. 

“Over the years as I’ve been traveling around, the No. 1 issue that I always hear is staffing. I hear it from residents, from families, from folks like yourself [CNAs], from directors of nursing, from owners, from administrators. Everyone always comes to the agreement that staffing is the number one issue that affects our industry,” Shulman explained. 

Research has shown that CNAs represent about 60% to 70% of nursing home expenses and that the group provides 80% to 90% of direct care to residents, noted David Grabowski, Ph.D., a Harvard Medical School healthcare policy professor. He also explained that more prolific CNA staffing often has been linked to fewer issues, such as deficiencies and hospitalization, and better outcomes among residents, such as higher satisfaction and quality of life. 

(Lack of) money talks

Grabowski also reported that the annual rate of CNA turnover is 129%. Despite that, CNAs often are paid close to the minimum wage and less than half have any health insurance coverage through their employer. Medicaid reimbursement isn’t sufficient enough to help curb this trend, Grabowski said. 

“Basically, you get what you pay for,” he said. 

Sabra Healthcare REIT CEO Rick Matros noted that with all the public civil unrest, now is the time for the industry to include CNA staffing issues in the dialogue. Doing so could look like better focusing demands for workers and suggested having a minimum wage standard of $20 per hour for CNAs built into the cost component of every state’s Medicaid system. 

“Our country is in a moment now that we have to take advantage of, that we have to push to have a different kind of culture. A culture that pays people well, that pushes people above the poverty line, that creates equal opportunity for everybody in our society regardless of their gender, ethnicity,” Matros said. “I think we need to work that into the dialogue.”

Shulman noted that CMS wants to focus on all issues that negatively affect the CNA workforce, which also should include addressing emotional support for workers, hiring competition and payment reform. 

“I’m really trying to chip away at what are all the things that we should consider as an industry to help tackle this problem from all aspects. From a Medicaid aspect, from a staffing recruitment aspect, from a population aspect, from a payment aspect, from a turnover aspect — from all different aspects that can help chip away at this problem that we have in CNA staffing,” Shulman said. 

He added that providers will see “more from CMS on turnover in the upcoming months and years. Had this pandemic not occurred, you probably would have seen something already.”