Certified Nursing Assistants: The Heroes of Long-Term Care

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Karl Andrew Pillemer is a Cornell University Gerontologist and Founder and Consulting Editor of Nursing Assistant Monthly

 

The COVID-19 crisis has placed a spotlight on long-term care facilities. Nursing home residents constitute over a third of all deaths from the pandemic, and in some states, half to two-thirds of all deaths occurred in these settings. In few other situations was the work life of staff so disrupted and stressful. The lockdowns meant that long-term care workers provided all the social contact residents received, even at the end of life. Staff worried about their own health; nursing home workers had among the highest COVID-19 death rates of any profession. The heroism and self-sacrifice are exemplified in staff like Denny Darby, a dedicated and beloved Certified Nursing Assistant (CNA)  about whom his supervisor said: “He ended up dying from doing what he loved to do.” Now more than ever, we need to recognize the invaluable role CNAs play in long-term care communities, and to honor and celebrate their contributions as pandemic heroes.

Who are the CNAs?

There are over 1.5 million CNAs working in nursing homes and assisted living facilities. Officially, their job is to help residents carry out their activities of daily living, under the direction of nursing staff—but as we will see below, they do much, much more. The CNA job does not require a high school diploma or past experience working with older people. Therefore, the training CNAs receive is absolutely critical to their success. Federal law mandates 75 hours of training, but many states and long-term care providers have expanded that requirement. Particularly critical is continuing education for CNAs, like that provided by the Nursing Assistant Monthly program, which delivers high-quality, up-to-date information on caregiving topics and meets certification requirements for continuing education.

CNAs Are the Key to Quality Care

The role of CNAs has changed dramatically over the past decade. CNAs are now widely acknowledged as the primary caregivers in nursing homes—not just as assistants to nurses. More than anyone else in a nursing home, CNAs are directly responsible for the daily care and quality of life of the resident. They are the people in the facility who know the individual resident’s needs, wishes, hopes, fears, abilities. CNAs are often the first to note subtle changes in mood, behavior, appetite, and general condition that may signal the need for tests or treatments by other members of the team.

But CNAs are even more than skilled, knowledgeable caregivers. A CNA also serves as companion, friend, and ally to residents. The tools of their trade are patience, empathy, and kindness. New buildings, fancy equipment, miracle medicines—none of these are as important to the quality of residents’ lives as the loving care they provide on a daily basis. Indeed, given the relatively low wages and difficult working conditions, the ability to relieve suffering and improve the quality of life for frail older persons is often a CNA’s primary motivation. In the words of one CNA: “I believe I’m working my way to heaven, just by doing my job. I’ve been a CNA for nearly 10 years now, and I wouldn’t trade my profession for any other. No other job touches another’s heart like being a CNA.”

What the Pandemic Has Taught Us

If we did not know it before, it is now clear that CNAs are the “unsung heroes” of the long-term care system. Their role on the front lines of combating the pandemic’s effects on the most vulnerable Americans shows that we cannot wait any longer to upgrade their jobs and recognize them as the caring professionals they are.

One of the key components of such recognition is improved training. Some areas for improved training are obvious, including better knowledge regarding infection control in the long-term care setting. However, much more is needed to help CNAs do their jobs well and to reduce turnover in long-term care. We must stop viewing CNAs as “unskilled workers”— indeed research shows that their jobs require unusually sophisticated skills, such as emotional intelligence, ability to handle conflict, and resilience in the face of the inevitable loss of residents. Just as CNAs are the key to quality care, the pandemic has shown us that comprehensive, innovative training is one of the keys to the quality of CNA work life. The ultimate beneficiaries will be the over 2 million people they serve in long-term care settings.

 

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