A bill that would permit non-certified nursing assistants to work in nursing homes has been reintroduced in the House of Representatives. This bill would allow individuals to work for longer than four months in a non-certified position.
The legislation H.R.7744, known as the Building America’s Healthcare Workforce Act, would temporarily exempt nursing assistants from completing 75 hours of state-sanctioned training as well as a competency assessment within a four-month period.
A similar waiver was put into place during the height of the Covid-19 pandemic, providing a fresh workforce after thousands of certified nursing assistants resigned from their positions. However, that waiver was revoked last summer, requiring non-certified nursing aids to either obtain certification within four months or leave their positions.
The new bill would restore the waiver for an additional two years, after the public health emergency is set to end in April 2023.
Reps. Brett Guthrie (R-KY) and Madeleine Dean (D-PA) are the lead backers of the legislation.
“Quality care for seniors in nursing homes continues to be threatened by historic workforce losses in nursing homes,” Guthrie said in a statement. “This legislation not only helps strengthen the nursing workforce to ensure seniors have access to safe and quality care, but this also provides an opportunity for workers to further their careers and earn higher wages.”
The bill is also supported by some of the nation’s largest nursing home advocacy groups, including The American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
According to the bill’s sponsors, the new legislation would have safeguards in place, including on-the-job competency evaluations that would assess the non-certified nursing assistants’ skills.
What happened to the original bill?
The original bill was introduced by Rep. Guthrie in May 2022 and had 44 co-sponsors (24 Republicans and 20 Democrats). However, it was unable to make its way out of the committee for a full vote.
It is expected that Guthrie will become the new chair of the Energy and Commerce Committee’s Health subcommittee this year, which could give the bill new life and a better chance of passing into law.
What does this mean for nursing aids?
Currently, nursing assistants have four months from the start of employment to obtain their CNA certification. If passed, the bill would allow nursing assistants to work in nursing homes without a certification for up to two years.
A much-needed lifeline or a patient safety risk?
Supporters of the legislation argue that allowing nursing aids to work without certification within the nursing home sector fills a gap in the workforce that continues to grow. According to the American Health Care Association (AHCA), nursing homes lost approximately 210,000 jobs between February 2020 and December 2022. A recent AHCA survey of nursing homes indicated that 96% of them were experiencing hiring difficulties. 45% of those surveyed said the employment situation had worsened since May 2022 when the legislation’s similar waiver expired.
Holly Harmon, Senior Vice President of Quality, Regulatory, and Clinical Services at AHCA/NCAL also claimed in a statement, “Federal data clearly shows that quality of care for residents remains high when temporary nurse aides are present.”
Colleen Knudson, a spokeswoman for LeadingAge and supporter of the legislation, also made a statement, saying, “Workforce challenges in nursing homes and other aging services settings continue to limit older adults’ and families’ access to care. Temporary nursing assistants play a critical role in building direct-care staff at a time when nursing homes remain unable to fill open positions. The reality is that providers are looking for workers that currently don’t exist, and the pipeline is shrinking daily. Addressing workforce shortages in long-term care has got to be priority No. 1. We support this bill and hope that members of Congress will as well. This is one of many initiatives that are needed to address shortages and also build a workforce pipeline for the future.”
Some states also claim that testing backlogs and lack of proctors have made it even more difficult to get temporary nursing aids certified. The two-year extension would give nursing home providers extra time to assist temporary nursing aids with completing the certification process.
Finally, supporters of the bill claim that the new legislation would improve continuity of care for residents by ensuring the nursing home does not have to terminate and rehire for a nursing aid role simply because of certification status.
Meanwhile, opponents of the bill insist that allowing nursing assistants to work without certification endangers patients and puts their safety at risk. In October 2022, spokespeople for Justice In Aging, an organization focused on improving advocacy for the elderly through law, wrote a letter to the Center for Medicare and Medicaid Services asking them to reinstate the certification requirements for nursing assistants employed at nursing homes.
They argued that nursing home residents often have complicated care needs and that reducing training standards is harmful to both aids and residents. They also stated that because nursing aids provide most of the direct care in nursing homes, comprehensive, professional training is essential for quality of care.
Justice In Aging also claimed in their letter that multiple states were violating federal law by granting certifications to temporary nursing aids who have not undergone official training. They argued that any on-the-job training they may have received during the Covid-19 pandemic would be tenuous at best, and professional training should still be a requirement in order to ensure patient safety.