Local Interventions to Address Workforce Shortage

Prior to the pandemic, most of the SNFs in Sonoma County had applied for waivers, because they weren’t able to staff CNAs at the required 2.4 FTE state standard.  I heard one administrator comment that the website “Indeed.com” had become a main source for attracting CNAs from other SNFs.  In our area, we do have a training program for CNAs through partnerships of facilities with the Red Cross and the local community college, but the number of CNAs attracted to this track has been small.  Since the COVID pandemic, our CNA shortage has been aggravated by concern for personal safety, complicated sick leave policies, inconsistent work hours, and the realization that those working in multiple facilities had a much higher risk of transmitting COVID.  

The CALTCM COVID Webinar on 11/9/20 focused on “Anxiety and Depression” management.   Within the greater Los Angeles Veterans Homes system, leadership found they had adequate staffing and that CNAs were able to provide enhanced personalized care and support virtual visit programs.  However, other speakers on this webinar noted that their facilities were only able to staff enough CNAs to support basic care and enhanced infection prevention protocols.  

On a recent California Partnership to Improve Dementia Care call, there was uniform agreement that the shortage of CNAs was hindering our facilities’ abilities to implement non-pharmacologic care plans.  On this call, administrator and past CALTCM Leadership Award recipient K.J. Page noted that her facility in Berkeley had not known CNA shortages prior to the pandemic, since they had 9 schools in the area training CNAs.  However, since the pandemic, most of these training programs have shut down, due to the required SNF internships not being allowed during the pandemic.  

In my county, an ALF (Assisted Living Facility) had an outbreak affecting all of their staff and residents.  Even with state and county efforts, they were not able to add outside HHA (Home Health Aide) staff to their care team during this crisis.  

In my former CCRC (Continuing Care Retirement Community), they have only been able to staff their SNF for care of their residents despite avoiding any COVID cases among their CCRC population.  Recently, they have been able to hire new licensed nurses, but have had much more difficulty finding and hiring CNAs.  Recently our Director of Nursing was able to hire 2 nursing students willing to take CNA training at our facility, for which we have now applied for a waiver from CDPH.  

In Sonoma County, we have a collaborative workgroup sponsored by one of our County Supervisors.  We meet weekly and have been focused on providing COVID messaging and enhanced services to our community elders.  I recently asked that we begin a conversation on how we could begin to address the critical shortage of CNAs and HHAs on a local basis, which has greatly limited the care capacity of our facilities.  I mentioned that one of my sources was aware of a partnership about a decade ago in Stanislaus County where their EDD/CA (Employment Development Department, CA) partnered with local CNA programs to recruit, fund, and train unemployed workers.  As a part of that conversation, a small HHA (Home Health Agency) has now been paired with a local donor to start a Home Health Aide training program.  In that same work group, an “Easy Money” grants opportunity was announced and that HHA has now submitted an RFP.  Over time, some of these HHA’s may become our future CNAs & licensed nurses.  

The conversation has just begun.  What are you doing in your community to address this critical workforce shortage?  Please share your experiences and ideas with us at CALTCM and our e-newsletter, The CALTCM WAVE.

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