As the American population ages, the nation faces a crisis in its long-term care system - a shortage of certified nursing assistants.
A new study from the University of Georgia College of Public Health suggests that a lack of resources and advancement opportunities may be exacerbating the problem.
CNAs make up about one-third of all staff in nursing homes. But they provide about 90% of direct care, from helping with eating, bathing and mobility to providing companionship and monitoring for signs of illness.
"I don't think most people realize what a CNA does on a day-to-day basis, how oftentimes they are really the go-to person for nursing home residents," said Curt Harris, co-author of the study and the director of the UGA College of Public Health's Institute for Disaster Management.
And the number of CNAs is dwindling.
The workforce shortage is not new, the researchers said. But it was intensified by the COVID-19 pandemic, during which nursing homes lost more than 220,000 employees, including many CNAs. This led to reduced quality of care for residents, heightened stress for remaining staff and an escalating cycle of burnout and attrition.
"The crisis just continues to build upon itself and grow and grow and grow," said Austin Dobbs, study co-author and emergency preparedness manager in the Institute for Disaster Management. "Something has to change. It can't keep going the way it's going because the system can't sustain itself."
Lack of awareness, financial constraints also play a role in CNA shortage
The study identified challenges in compensation, recruitment and retention as key factors in the shortage.
Direct resident care can take a physical and emotional toll, Harris said, and CNAs often lack access to mental health resources.
"The amount of care that they provide and the amount of baggage that they take home with them leads to significant turnover," Harris said.
Barriers to training, a general lack of awareness of the career, financial constraints and accessibility of certification tests all lead to lower CNA retention.
And it doesn't end once a CNA enters the workforce.
Insufficient career advancement opportunities, as well as disrespect from colleagues and residents, hamper retention in the field, according to the study.
Advocacy, increased access to training key to addressing CNA shortage
Advocacy for CNAs and other members of the long-term care facility workforce is key, according to the researchers. Pushing for improved access to training, setting up tracks for career advancement and supporting initiatives to increase pay and funding support are a few examples, Dobbs said.
Other potential solutions include building on grant-funded work like the Georgia CNA Career Pathway Initiative, which addressed early barriers to the workforce. This also led to the CNA Virtual Skills Evaluation program, which helps CNAs overcome testing barriers. As a result of this program, more than 6,000 Georgia CNAs took their skills evaluations virtually, increasing access to the field.
You don't need a degree to be an advocate. You just need to care." -Curt Harris, College of Public Health
"What is keeping disaster at bay is the incredible individuals that are working out in the field right now: from CNAs in the field, students studying to become CNAs, those training them in the training programs across Georgia and beyond in the United States," Dobbs said. "They are the heroes in the story. But they need support. Be an advocate for those who are caring for your loved ones."
"You don't need a degree to be an advocate," Harris said. "You just need to care."
