Hawaii County Struggles With Shortage Of Certified Nursing Assistants - Honolulu Civil Beat

About the Author

Paula Stanfield

Paula Stanfield is a semi-retired RN living on the Big Island. She works part time as Certified Nursing Assistant instructor.

Fortunately, two nursing homes are showing how to make a dent in the CNA deficit.

Most of us living here on the Big Island agree we live in paradise, despite the shortage of doctors and nurses. We deal with the inconvenience of traveling to Honolulu for specialty care as part of the price of admission. 

As a semi-retired nurse working as a Certified Nursing Assistant instructor in Hilo, I know firsthand that Hawaii has a shortage of CNAs. This shortage, which is everywhere in the U.S, has a huge impact on our islands and mainland nursing homes, as most CNAs work in nursing homes.

Contributing to the crisis the aging of family members at home who no longer can care for themselves. Some student CNAs take the CNA course to learn how to care for their parents or grandparents. 

Our Hawaii nursing homes are affected by the worrisome shortage of nurses and CNAs. Nursing homes in the U.S. lost nearly 250,000 workers during the pandemic. Current staffing is at 1995 levels.

Some mainland nursing homes have shut down due to the shortage. CNAs tell me that they get daily calls asking them to work extra shifts, or at least a few extra hours. They are tired.

In my opinion, CNAs are the backbone of staffing in nursing homes. They give most of the direct physical care to residents, such as bathing, feeding, and toileting. We teach them the importance of relating to each resident as an individual person with psycho-social needs too.

May 2023 Mid Pacific Medical Training Institute CNA graduates with instructor Paula Stanfield at LifeCare Center, Hilo. (Courtesy)

Relationships are formed that encourage residents and foster happiness. We teach them the important role CNAs have by virtue of spending more time with residents than other staff do. Residents look forward to seeing them and know them by name.

CNAs are more likely to observe subtle changes in condition, from a new cough to a low mood. They use critical thinking to determine how to handle a problem or when to report it to the nurse.

When staffing is minimal due to the shortage, there may only be time to meet the basic physical needs. There is less time for each resident, and there is greater CNA stress.

Stress leads to burnout. CNA turnover rate in 2022 was 54.8%. Nursing homes everywhere continue their struggle to find qualified applicants as they compete with other sectors, who may offer higher wages. The national median hourly rate for CNAs is $16.87.

President Biden has proposed a minimum staffing requirement rule for nursing homes that receive federal funding.

While there is debate over whether a standard number of residents per CNA is needed, most agree CNA stress relief is important. Nursing home administrators locally and on the mainland are stymied over how to afford the mandated staff increase and how to find candidates for the jobs. 

Solutions In The Works

Recently, two nursing homes in Hilo where I supervise CNA students — Life Care Center and Hale Anuenue Restorative Care Center — started innovative and refreshing programs to help meet the challenge of the CNA shortage. The programs pay for CNA training for those employed as a Hospitality Aid (HA). Upon earning a CNA Certification, the HA is promoted to CNA.

Training and certification of CNAs was mandated by the Nursing Home Reform Act of 1987. The Act set federal quality standards to ensure that seniors in nursing homes receive high quality care.

So far, 21 HAs have graduated and four are currently enrolled in the CNA training program at Hilo’s Mid Pacific Medical Training Institute, according to administrator Linda Sweinhart. 

Hiring HAs and transitioning them to CNAs provide several benefits including:

  • more hands-on deck for non-skilled tasks such as passing meal trays and answering call lights;  
  • greater resident satisfaction from more time spent with them for both their physical and psycho-social needs;
  • shorter waits for call lights to be answered; and 
  • greater CNA job satisfaction, less burnout and less turnover.

Lori Martines is an RN who works as director of nurses at the Life Care Center. She told me that she wants the community to know the challenges CNAs are experiencing, how they are meeting them and about the pride that comes from providing respectful and compassionate care to the residents.

I agree with that, as well as Lori’s hope that more people in the islands will consider becoming a CNA. 

I see the rewards of being a CNA come as smiles from residents, and the satisfaction of doing one’s best to bring comfort to those in need. Being a CNA also can be a steppingstone to becoming a registered nurse; CNAs receive four points towards the University of Hawaii’s Community College Nursing Program admission criteria point allocation. 

CNAs are a critical factor in the well-being of residents and are in short supply. For more information, please contact Life Care Center, Hale Anuenue or Mid Pacific Medical Training Institute.

I also want to remind readers that, fortunately, each island has an Executive Office of Agingincluding Hawaii County — with many resources, including financial, to help families care for aging family members at home. And for those who do not have access to being cared for at home, there are assisted living/care homes and nursing homes in Hawaii. On the Big Island, for example, there are seven assisted living/care homes and seven nursing homes.

Lastly, please recognize that June 15-21 is CNA Week 2023, a time to pay respects “to the incredible work that the nearly 1 million-strong contingent of frontline heroes does everyday for elders and people with disabilities.”

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About the Author

Paula Stanfield

Paula Stanfield is a semi-retired RN living on the Big Island. She works part time as Certified Nursing Assistant instructor.

Latest Comments (0)

I know you will probably not print this since I used up my one comment but I am hoping someone at CB will feel it might be important enough to let me finish my thoughts. I feel the process is broken. If there was a way to speed-up the permitting process for private ARCH's and DOH is given special funding targeted at helping the ARCH's succeed with more timely training and inspections it will help on sector of caregiving. Training CNA's is not the major problem. It is finding enough people who want to be CNA's. As the article alluded to, it is not an easy job, since it weighs on a person both physically and mentally as they help people in the dying process. I strongly feel tapping the CNA and RN market from the Philippines and making it possible for them to migrate to Hawaii on a work visa would go a long way to easing the shortage of care workers. The last part would be for the State to step-up their initiative to provide affordable housing for the medical field for members under a certain income level.

Ken · 3 months ago

I understand the concept but I do not see how this will help the one most critical area which is in-home care. Most elderly want to age in place and don't want to go to an institution especially since there is a lack of beds as well as staffing. I feel the the elephant in the room is the Adult Residential Care Homes (ARCH's) This is a cross between being at home vs. an institution but much more affordable for families. Many families can't afford the care of a large facility. Unfortunately there is the licensing issues. It starts with the remodeling of a home to convert it into and ARCH. The permitting process is extremely slow and can take up to a year so in some cases they are remodeled and operated without the final permitting approval. The the other portion is the DOH does not have the manpower to properly inspect the ARCH's so they are on a schedule for inspections and will call for an inspection appointment rather than show-up announced. The largest caregiving workforce is the unpaid caregivers that take care for family members and friends. Our government leaders just do not see this as a critical need for Hawaii since it is not a shiny train or resort type training center.

Ken · 3 months ago

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