Nearly 20 percent of certified nursing assistant jobs in Rhode Island are unfilled — partly because the positions don’t pay well enough — and the shortage of CNAs is hampering the quality of care in many of the state’s nursing homes, according to government and health-care officials.
In an effort to recruit and retain more nursing-home CNAs, Congressman Patrick Kennedy, D-RI and Lt. Gov. Charles Fogarty last week urged Rhode Island legislators to earmark more than $14 million to help fund a sharp increase in the salaries of private-sector CNAs.
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The proposed funding would boost private CNA salaries to about $11 an hour, well above industry’s average starting wage of between $7 and $8.60 an hour. The state dollars would be matched by nearly $16 million in federal Medicaid funding, Fogarty said, for a total of $30 million.
Fogarty and Kennedy said the increase would bring private-sector CNAs’ salaries more in line with those of state-employed CNAs, who earn nearly $12 an hour.
“It is incomprehensible to think someone could stay in a position and get paid dirt wages when somebody working for the state is being paid twice as much, with benefits,” Kennedy told an audience last week at the Slater Health Center in Pawtucket. Most attending were CNAs and nursing-home residents and their family members, many wearing buttons reading “Save the CNA!” Kennedy sits on the House Appropriations Committee’s subcommittee that administers health-care spending.
Of the roughly 27,000 CNAs who have received licenses in Rhode Island in the past decade, only about half are employed at nursing homes, according to a recent report from the state’s Long Term Care Coordinating Council. Many have left for better-paying jobs in other fields, leading to an alarming turnover rate of more than 80 percent among state CNAs.
CNAs feed, bathe, groom and dress nursing home patients, among other duties. They are required to take a training program of at least 100 hours and pass a state-administered test.
The CNA shortage is eroding quality of care for nursing-home residents at Rhode Island’s 106 nursing facilities, officials and health care workers said.
“The impact that the staffing shortage is having on quality of care is enormous,” said Tara Russell, a CNA at Eastgate Nursing and Recovery Center in East Providence. “We don’t have time for conversation or to offer emotional support. Our legislature needs to realize there is a crisis going on in Rhode Island’s nursing homes.”
While a nursing shortage is afflicting providers in virtually all health-care sectors across the country, the problem with care is particularly acute at nursing homes, which employ a higher percentage of CNAs than other providers.
Nursing home operators say they can’t raise CNA salaries substantially because reimbursement rates from state and federal programs such as Medicaid have been slashed in recent years. Nursing homes in Rhode Island receive as much as 80 percent of their revenues from Medicaid and other federal funding sources. The cutbacks have forced most of the country’s largest nursing-home chains into bankruptcy over the past two years. In Rhode Island, roughly 15 percent of nursing-home beds are in facilities that either are bankrupt or have closed.
What’s more, older patients in need of 24-hour assistance are less likely to stay in hospitals, which have looked to cut costs by admitting fewer patients in recent years. Those patients are ending up in nursing homes, officials say.
“Nursing homes are dealing with people who used to stay in the hospitals,” said Roberta Hawkins of the Alliance for Better Long Term Care, an advocacy group for nursing-home patients. “These patients aren’t still (in hospitals) because the federal government won’t pay for them to stay there. Now our state won’t pay for them to stay (in nursing homes).”
The staffing shortage is not likely to subside, as the population ages with baby boomers reaching retirement. Rhode Island already has the country’s third-highest percentage of people 65 and older. The state’s nursing homes must staff an additional 567 CNAs each year through 2008 to meet increased demands for long-term care, according to the state’s long-term-care report.
