As federal regulators consider toughening minimum staffing requirements, the trade association for long-term care centers in Michigan has been working to upgrade the skills of caregivers.
The apprenticeship program the Health Care Association of Michigan launched in late 2022 with the support of state grant funding will provide added training and mentoring for more than 200 certified nurse’s aides by the time it ends this summer.
While that’s a fraction of the workforce that left the long-term care profession in the pandemic, it is 200 people that the apprenticeship program has helped to retain staff and elevate their skills, sources said.
“Our members would say that you’re taking our certified nurse aide, our direct care, front-line workers, and giving them a little additional training,” said Melissa Samuel, president and CEO of the Health Care Association of Michigan, which represents nearly 360 nursing homes and more than 280 assisted living centers in the state.
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“It makes them stronger (and) more complete in the job that they’re doing to have this additional knowledge,” Samuel said. “It makes them a stronger employee capable of doing a bit more.”
Backed by a grant from the Michigan Department of Labor and Economic Opportunity, the apprenticeship program pays $3,000 per position for nurse’s aides to upgrade their skills and earn certification, enabling them to advance in their career and achieve higher earning power. That helps to retain staff in an industry that was “decimated” in the pandemic and lost 16% of its workforce, or about 10,000 people.
In working to address what Samuel describes as “a massive problem” for long-term care providers, the association wants to retain people in the profession and attract new workers to long-term care.
“Most other health care settings have recovered to pre-pandemic levels with their workforces. Long-term care has not. There’s not a skilled nursing facility in the state that does not have openings for positions, and so it’s just critical that we give our members tools in the toolbox,” Samuel said. “We got beat up pretty badly through the pandemic, and it’s a certain individual that’s going to come and work in the sector to begin with. It’s truly a calling. We have to work harder and different to attract workers back into the sector.”
The apprenticeship program represents one front in the long-term care industry’s battle to rebound from the workforce losses in the pandemic. In another, state laws enacted in 2023 enable certified nurse aides to upskill and become registered medication aides in skilled nursing centers.
Medication aides focus solely on distributing medication to residents and patients, freeing up registered nurses for other clinical tasks, Samuel said.
“They’re building out that program right now and we hope to have that in place later this year to where our members can start putting these employees through that additional training to become a medication aid,” she said.
The Health Care Association of Michigan is seeking additional grant funding to help long-term care providers with talent recruitment and retention and upgrade staff skills. For example, a request to the Michigan Health Endowment Fund would go to support dementia care training at assisted living centers, Samuel said.
More staffing mandates ahead?
As the industry tries to recover from the pandemic’s toll, long-term care providers face heightened minimum staffing requirements for nurses that they say will only worsen their plight at a time when attracting staff is difficult. The federal Centers for Medicaid & Medicare Services could finalize a rule this spring that would come without any additional funding to meet the higher staffing requirements.
“My passion for trying to make a difference in the lives of vulnerable adults includes attracting, hiring, and retaining qualified nursing staff to care for them. It has proven to be extremely challenging due to the lack of available caregiving talent,” Pennie Westers, executive director at the 119-bed Life Care Center of Plainwell, wrote in a comment submitted in November to CMS during a public-comment period. “Our concerns are not with a minimum staffing requirement — our issue is the availability of any additional staff needed to meet any minimum standards that might be established along with the resources to pay for any additional staffing. The ‘one-size fits all’ standard does not provide the flexibility to appropriately staff the skilled nursing facility based on the type and acuity of the patient being served.”
“This rule is proposed at a time where we are encountering significant headwinds hiring qualified staff. Preferably you would not institute this rule at this time,” Brittney Morse, administrator at Freedom Village Holland, wrote in an October 2023 comment to CMS.
‘Impossible situation’
Patient and consumer advocates argue that tighter minimum staffing ratios are needed to ensure patient safety and raise the quality of care.
Fourteen state attorneys general, including Michigan’s Dana Nessel, argued in a November comment letter to CMS that many long-term care facilities “have been deliberately understaffed to reduce operating expenses and enable owners, operators and related parties to siphon profit from them, particularly by far too many corporate for-profit owners and operators, for far too long.”
The attorneys general urged CMS to adopt the rule, which includes having an RN on site 24 hours a day so “that vulnerable nursing home residents receive safe and reliable care in these facilities.”
“The significance of adequate nursing staff presence and availability on long-term residents’ overall health outcomes has never been more tested or apparent after seeing the negative impacts resulting from staffing shortages during COVID-19’s inception and spread. Over 200,000 nursing facility residents and staff died due to COVID-19 since the start of the pandemic, accounting for at least 23% of all COVID-19 deaths in the United States,” the attorneys general wrote in their letter that urged even tougher mandates than what CMS proposed. “These tragic outcomes are reflective of facilities that are chronically understaffed and often fail to provide basic support to residents, such as hygiene, wound care, and feeding/hydration.”
The Health Care Association of Michigan’s Samuel worries that the staffing mandate could lead to nursing homes closing beds, turning away people, and reducing capacity at a time when more is needed to accommodate an aging population. To meet the minimum staffing mandate as presently written, nursing homes in Michigan would have to hire an additional 2,600 certified nurse’s aides and 466 registered nurses, she said.
“When you layer the positions that are going to be needed to meet the mandate, if it were going to go into effect, it’s just going to be impossible to meet,” she said. “It’s an impossible situation that we’re in.”
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