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A Pittsburgh nursing home looks to in-house training and better pay to ease a staffing shortage

CNA trainees Andrew Williams (left) and Tyler Edwards practice changing the sheets of an occupied medical bed at Kane Community Living Center's Glen Hazel facility.
Sarah Boden
CNA trainees Andrew Williams (left) and Tyler Edwards practice changing the sheets of an occupied medical bed at Kane Community Living Center's Glen Hazel facility.

CNAs provide the bulk of direct patient care within nursing homes, such as washing residents’ hair, changing their soiled clothes or soothing their anxieties. But many nursing homes are finding it difficult to fill these positions.

Before COVID-19, Kane Community Living Center’s Glen Hazel facility, one of four nursing homes owned by Allegheny County, has started to train its own certified nursing assistants, or CNAs.

Previously, Kane didn’t hire care aides unless they were already licensed. Federal law requires a nursing home to reimburse recent CNA graduates for the expense of their certification. This can be more cost-effective for a nursing home than training CNAs in-house; the pandemic changed that.

Skilled Labor

A narrow, medical bed is set up at one end of a first-floor conference room in Kane’s Glen Hazel facility. Tyler Edwards and her classmate Andrew Williams have spent the last couple of weeks in this make-shift classroom learning skills they’ll need as CNAs.

Edwards and Williams carefully maneuver a mannequin as they practice changing the sheets of an occupied bed. Before folding up the blankets, Edwards placed a sheet over the mannequin’s hips.

“That’s just kind of to keep him covered for dignity, cause that’s one of their rights,” she said. “Everybody should have dignity; you don’t want everybody seeing all your goods.”

It became apparent by fall of 2020 that Kane was going to have to start training its own nursing aides to keep facilities staffed, said chief nursing officer Nancy Erhman. To do this, Kane had to get state certified through Community College of Allegheny County and find instructors.

“It took a good six months,” said Erhman. “There were pages of requirements.”

So far, Kane says eight people have completed the CNA training, which costs it $1,649 per student. Even though graduates are guaranteed a job upon certification, recruitment has been a bit slow.

High turnover

Despite Kane paying for the training, CNAs are not required to work for Kane. If they take the job with Kane, the chances someone stays long term aren’t good. One pre-COVIDstudy found less than one in 10 U.S. nursing home workers remain with a facility longer than a year.

“Even people who started in our program a few months ago aren’t even at the facilities anymore,” said Barbe Conrad of the Training and Education Fund, which works with unionized nursing homes to recruit and mentor CNAs. “We vet them, we tell them about everything they’re going to get into, but once you get there and do that work, it’s hard.”

To improve retention, Conrad said pay for nursing aides needs to increase. Without overtime, the average CNA in Pennsylvania makes less than $40,000 a year.

Better pay

For its part, Kane has increased salaries and overtime pay. Data suggests this compensation bump is a nationwide trend, according to data from the Hospital & Healthcare Compensation Service. In October, a report from the private research firm found that CNA salaries rose by more than 7% last year; in 2019, it was 3%.

More generous compensation and benefits will become the industry standard, predicts Zach Shamberg, head of the Pennsylvania Health Care Association, a trade group for the state’s nursing homes. He says some facilities are now offering 401K matches and referral or retention bonuses. One nursing home in eastern Pennsylvania is even trying to help staff find affordable childcare.

“To not just remain competitive with the nursing home down the street, but other service industries,” said Shamberg. After all, an aide can walk out of their nursing home and find an entry-level position at a warehouse or coffee shop where they’ll make roughly the same hourly rate, if not more.

The wrinkle in meeting market demands with retention bonuses and double overtime is that many nursing homes say they can’t sustain these costs. If that happens, many nursing homes may eventually have to shut down.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.