Short on care
When Coeur d’Alene Homes opens its $6 million Alzheimer’s and dementia center this fall, finding clients should be no problem, said Director Mike Grabenstein.
Waiting lists are forming already for up to 70 spots in the North Idaho assisted living and “memory care” programs.
Far more difficult than acquiring patients will be attracting – and keeping – the dozens of certified nursing assistants needed to care for them.
“Finding qualified staffing looks like it will be the real concern, not only for us, but most health care facilities in the area,” said Grabenstein, who will require 40 CNAs – twice the number he now employs – by September.
“It’s not to the point of panic, but it’s something you need to think about.”
Across the Inland Northwest, longstanding nursing assistant shortages are getting worse as the general population ages, experts said. In an industry notorious for low wages, hard work and high turnover, it’s becoming increasingly difficult to hire and maintain qualified helpers.
“They’re not going into that profession anymore. It’s not glamorous,” Grabenstein said.
Some employers have turned to signing bonuses, retention pay and other incentives to entice employees to work – and work hard. At one Spokane home health care agency, nursing assistants can receive restaurant dinners, movie tickets, gas money and cash prizes just for showing up to work all week.
“It is a never-ending battle,” said Troy Marshall, president of At Home Care, which employs about 45 nursing assistants to care for 60 clients.
Nursing assistants go by a variety of names and work in a variety of settings, including nursing homes, assisted living centers and private households. Typically, they’re responsible for intimate personal care of ill, infirm and elderly people.
However, some assistants, like Sue Murphy of Coeur d’Alene Homes, can also dispense medication under a registered nurse’s supervision.
“It’s a lot of responsibility,” said Murphy, 49, who provides medication – including narcotics – to 36 clients a day. “When you’re in here and the whole room is abuzz, you really have to focus,” she said.
Murphy started out in housekeeping five years ago. She took a course, passed state competency tests and joined some 13,000 certified nursing assistants on Idaho’s registry. In Washington, some 37,000 nursing assistants obtain either registration or certification.
As a longtime CNA, Murphy is an anomaly. In Idaho, turnover rates routinely top 100 percent, a figure that surprises only those new to the issue.
“It’s certainly common knowledge to us,” said Dennie Seymour, director for workforce development for North Idaho College.
Every six weeks, Seymour enrolls another 15 people in the 120-hour class required for CNAs to be placed on Idaho’s registry.
For nearly all of them, finding a job is no problem, educators and employers said. For some, however, maintaining employment can be difficult.
“If we could only teach work ethic,” said Seymour, whose comments were echoed by employers.
While most nursing assistants are dedicated, caring employees, some staffers skip work, show up late or job-hop without warning. Others have questionable backgrounds that prohibit them from being hired in the first place, noted Marshall.
A standing newspaper ad might net Marshall 50 inquiries a week. “I might schedule 25 for interviews,” he said. “Of those, I might hire two.”
The chief problems are pay and staffing levels, experts said. In Idaho, wages start at around $6 an hour and range to a high of less than $9. There’s no mandated ratio of staff to clients, said Robert Vande Merwe, executive director of the Idaho Health Care Association. Conditions are better in Washington, where pay typically is about $1 an hour more.
Solving the problem of staffing shortages and high turnover would appear to be simple. First, find a way to increase the pool of potential nursing assistants, said Vande Merwe. One way to do that would be to allow a waiver of the English-only requirement for workers seeking to take competency tests, he said.
“Here we are dying without enough CNAs and there a lot of people all around us who want to do the job,” he said. “A nurse from the Philippines, a nurse from Russia, couldn’t even be a CNA because they didn’t speak well enough to pass the test.”
An informal proposal was dismissed by state officials who said Idaho’s population is not yet diverse enough to warrant such a move.
“How could they read a case plan?” said Ross Mason, spokesman for the state Department of Health and Welfare. “It’s just not practical.”
A more basic fix would work, too, said Seymour.
“The solution would be to improve the conditions and the pay,” she said. “I’m told that’s not possible.”
Failure to address the problem will directly impact the growing population of elderly people expected to flood health care centers in the Inland Northwest and across the nation. Idaho’s population of people 65 and older is expected to top 180,000 by 2010 and 360,000 by 2030, U.S. census projections showed. Washington could see 1.5 million people older than 65 by then.
Many will be like Darlene McCollam, 67, who is one of Sue Murphy’s regular clients at Coeur d’Alene Homes. With her warm brown eyes and bright smile, Murphy offers a daily dose of kindness along with medical procedures and pills. If Murphy were to leave abruptly it would leave her “a little nervous,” McCollam said.
“It’s a family – that’s really what it is,” she said.