Hawaii County Struggles With Shortage Of Certified Nursing Assistants

Fortunately, two nursing homes are showing how to make a dent in the CNA deficit.

Most of us living here on the Big Island agree we live in paradise, despite the shortage of doctors and nurses. We deal with the inconvenience of traveling to Honolulu for specialty care as part of the price of admission. 

As a semi-retired nurse working as a Certified Nursing Assistant instructor in Hilo, I know firsthand that Hawaii has a shortage of CNAs. This shortage, which is everywhere in the U.S, has a huge impact on our islands and mainland nursing homes, as most CNAs work in nursing homes.

Contributing to the crisis the aging of family members at home who no longer can care for themselves. Some student CNAs take the CNA course to learn how to care for their parents or grandparents. 

Our Hawaii nursing homes are affected by the worrisome shortage of nurses and CNAs. Nursing homes in the U.S. lost nearly 250,000 workers during the pandemic. Current staffing is at 1995 levels.

Some mainland nursing homes have shut down due to the shortage. CNAs tell me that they get daily calls asking them to work extra shifts, or at least a few extra hours. They are tired.

In my opinion, CNAs are the backbone of staffing in nursing homes. They give most of the direct physical care to residents, such as bathing, feeding, and toileting. We teach them the importance of relating to each resident as an individual person with psycho-social needs too.

May 2023 Mid Pacific Medical Training Institute CNA graduates with instructor Paula Stanfield at LifeCare Center, Hilo. (Courtesy)

Relationships are formed that encourage residents and foster happiness. We teach them the important role CNAs have by virtue of spending more time with residents than other staff do. Residents look forward to seeing them and know them by name.

CNAs are more likely to observe subtle changes in condition, from a new cough to a low mood. They use critical thinking to determine how to handle a problem or when to report it to the nurse.

When staffing is minimal due to the shortage, there may only be time to meet the basic physical needs. There is less time for each resident, and there is greater CNA stress.

Stress leads to burnout. CNA turnover rate in 2022 was 54.8%. Nursing homes everywhere continue their struggle to find qualified applicants as they compete with other sectors, who may offer higher wages. The national median hourly rate for CNAs is $16.87.

President Biden has proposed a minimum staffing requirement rule for nursing homes that receive federal funding.

While there is debate over whether a standard number of residents per CNA is needed, most agree CNA stress relief is important. Nursing home administrators locally and on the mainland are stymied over how to afford the mandated staff increase and how to find candidates for the jobs. 

Solutions In The Works

Recently, two nursing homes in Hilo where I supervise CNA students — Life Care Center and Hale Anuenue Restorative Care Center — started innovative and refreshing programs to help meet the challenge of the CNA shortage. The programs pay for CNA training for those employed as a Hospitality Aid (HA). Upon earning a CNA Certification, the HA is promoted to CNA.

Training and certification of CNAs was mandated by the Nursing Home Reform Act of 1987. The Act set federal quality standards to ensure that seniors in nursing homes receive high quality care.

So far, 21 HAs have graduated and four are currently enrolled in the CNA training program at Hilo’s Mid Pacific Medical Training Institute, according to administrator Linda Sweinhart. 

Hiring HAs and transitioning them to CNAs provide several benefits including:

  • more hands-on deck for non-skilled tasks such as passing meal trays and answering call lights;  
  • greater resident satisfaction from more time spent with them for both their physical and psycho-social needs;
  • shorter waits for call lights to be answered; and 
  • greater CNA job satisfaction, less burnout and less turnover.

Lori Martines is an RN who works as director of nurses at the Life Care Center. She told me that she wants the community to know the challenges CNAs are experiencing, how they are meeting them and about the pride that comes from providing respectful and compassionate care to the residents.

I agree with that, as well as Lori’s hope that more people in the islands will consider becoming a CNA. 

I see the rewards of being a CNA come as smiles from residents, and the satisfaction of doing one’s best to bring comfort to those in need. Being a CNA also can be a steppingstone to becoming a registered nurse; CNAs receive four points towards the University of Hawaii’s Community College Nursing Program admission criteria point allocation. 

CNAs are a critical factor in the well-being of residents and are in short supply. For more information, please contact Life Care Center, Hale Anuenue or Mid Pacific Medical Training Institute.

I also want to remind readers that, fortunately, each island has an Executive Office of Agingincluding Hawaii County — with many resources, including financial, to help families care for aging family members at home. And for those who do not have access to being cared for at home, there are assisted living/care homes and nursing homes in Hawaii. On the Big Island, for example, there are seven assisted living/care homes and seven nursing homes.

Lastly, please recognize that June 15-21 is CNA Week 2023, a time to pay respects “to the incredible work that the nearly 1 million-strong contingent of frontline heroes does everyday for elders and people with disabilities.”

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