February 4, 2023

A bill that would allow uncertified nursing assistants to work in nursing homes for more than four months has been brought back into the House of Representatives.

Reps Brett Guthrie (R-KY) and Madeleine Dean (D-PA) support the Building America’s Health Care Workforce Act, which would waive the requirement for temporary nursing assistants to complete 75 hours of state-approved training and a competency assessment every four months . At the start of the pandemic, a similar layoff re-staffed nursing homes after thousands of registered nurses lost their jobs.

The Centers for Medicare & Medicaid Services allowed the waiver until sundown last summer, forcing TNAs in most states to become certified or leave their positions by October. The agency granted additional waiver extensions to at least 15 states and dozens of individual providers, but in most cases these were tied to public health emergencies.

The new nursing assistant waiver legislation would restore the allowance statewide for two years beyond the public health emergency, which is currently scheduled to end in April.

“Quality care for seniors in nursing homes continues to be threatened by historic nursing home staffing losses,” Guthrie said in a statement. “Not only does this legislation help empower caregivers to ensure seniors have access to safe, quality care, but it also provides workers with opportunities to advance their careers and earn higher wages.”

A similar bill introduced by Guthrie at the last session garnered 44 co-sponsors but never made it out of committee for a full vote. This year, however, Guthrie is expected to chair the health subcommittee of the Energy and Trade Committee, which could give the bill a leg up. It had 19 co-sponsors at its launch.

The country’s two largest nursing home advocacy groups pushed lawmakers on the TNA issue last summer and fall, fearing the loss of newly hired workers who had the potential to build long-term careers in the nursing home sector.

LeadingAge, in particular, had argued for TNA’s flexibility by an additional 24 months and for CMS to count on-the-job training toward the 75-hour government requirement. Speaker Colleen Knudsen on Wednesday praised the reintroduction of the House bill.

“Occupational challenges in nursing homes and other retirement care facilities continue to limit access to care for older adults and families. Temporary nursing assistants play a critical role in building direct care staffing at a time when nursing homes remain unable to fill vacancies,” she said.

“The reality is vendors are looking for workers that don’t currently exist, and the pipeline is shrinking by the day. Addressing labor shortages in long-term care must be priority #1. We support this bill and hope members of Congress will do the same. This is one of many initiatives needed to address shortages and also build a workforce pipeline for the future.”

The American Health Care Association reported earlier this year that nursing homes lost 210,000 jobs between February 2020 and December 2022, with workforce recovery in 2022 slower than forecast. The sector’s workforce is at 1994 levels, but providers have added an average of 3,700 new jobs per month since last summer.

About 96% of nursing homes that participated in a recent AHCA survey said they were “experiencing recruitment difficulties,” while 45% said their staffing situation had deteriorated since May 2022. Many of these facilities are in dire need of nursing assistants, whose presence is necessary to meet many state minimum staffing levels and keep doors open.

A longer waiver could be a lifeline

Among the states granted waivers to retain temporary nurses last fall was Pennsylvania, where the state faced large testing backlogs caused by COVID shutdowns and the state’s testing company’s inability to hire nurses.

“In the months since Pennsylvania’s TNA program was renewed, our providers have seen dramatic improvements in the certification process, but there are still examples of limited availability and lack of testing capabilities,” Zach Shamberg, president and CEO of Pennsylvania Health, told the nursing association on Wednesday with “When PHE ends this spring, there is a real possibility that TNAs will be removed from their post because their certification is not complete… A two-year extension of the TNA program would give nursing home providers more time to better ensure TNA become a certified nursing assistant.” could successfully complete the certification process to stay at the forefront.”

Co-sponsor Dean also noted that the law “will help TNAs gain more time and first-hand experience in long-term care facilities so they can learn and grow in their careers.”

Consumer groups have protested the extension of TNA training times, arguing that it jeopardizes patient safety, and this was a stance CMS took to end a wide waiver.

The sponsors of the new nursing assistant waiver bill said this week that the bill includes safeguards, including competency assessments that evaluate temporary nursing assistants based on a variety of factors, such as: B. Basic care, personal attention and interpersonal skills; and mental health and social service needs. They said it would also improve continuity of care for residents, rather than forcing care homes to hire and rehire for the same roles when certification isn’t immediately attainable.

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