Underpaid and understaffed, nursing aides need a break - now | Editorial
Two years ago, our Legislature passed a bill designed to boost the number of Certified Nursing Assistants in nursing homes at any given time, and virtually everyone agreed this was a smart idea prescribed by simple math: It called for one caregiver per 8 patients during the day, one per 10 residents in the evening, and one per 16 residents overnight.
But the bill was vetoed by Chris Christie. So these nursing aides – or CNAs, who have perhaps the most demanding, back-breaking, heart-wrenching jobs in the health care industry – went back to juggling more patients than one person could reasonably handle.
Then the Senate passed an identical staffing ratio bill last year, so help appeared to be on the way.
But when that bill finally made it out of the Assembly Appropriations Committee last week, it was put through a Cuisinart: All references to “Certified Nurse Aides” in the staffing ratio formula were changed to “direct care staff member,” which includes any registered nurse, licensed practical nurse, or CNA at a facility.
This is a problem, because it doesn’t change the CNA-to-patient ratio. RNs and LPNs, who are more adequately staffed, perform different functions. This bill was supposed to increase the number of CNAs in New Jersey, which a national watchdog group, Families for Better Care, ranked 45th nationally for being “woefully understaffed.”
The tighter the ratio, the more time each aide has for our elderly – whether it’s feeding, bathing, grooming, dressing, lifting, toileting, or any nurturing task that the professional nurse doesn’t have time to do.
But if the aide has too many seniors to attend to, those patients aren’t as safe and comfortable as they should be.
So what happened with the bill? Nobody seems to know, and that’s troubling. Chair John Burzichelli, D-Gloucester, said he wasn’t involved in the final draft, but admits that when it left his committee, “nobody was happy with it.” The bill’s sponsors did not return phone calls.
We only know that the Health Care Association of New Jersey and the NJ Hospital Association, which represent many of the 367 nursing homes in our state, were delighted to include all the nurses in the staffing formula. As HCANJ president Jon Dolan sees it, RNs and LPNs “also provide crucial direct care. This shouldn’t be about one category.”
Assembly Speaker Craig Coughlin won’t say whether he endorses it, but the fact that he did not allow a floor vote is telling: The priority is to improve quality of seniors’ lives, and Coughlin probably knows this bill doesn’t accomplish that. This version treats the CNAs, who are on the front line of the nursing industry, as an afterthought.
“That’s a valid conclusion,” said Sen. Joseph Vitale, D-Middlesex, who chairs the Senate Health Committee.
“The Senate bill was watered down by including RNs and LPNs in the ratio. That does little or nothing to increase Certified Nurse Aides, which is the root of the problem and the basis for the original legislation. Little wonder why the HCA supports the bill, because it probably won’t increase labor costs at these nursing homes, which are doing pretty well.”
This bill needs another rewrite when the Legislature returns after summer recess. Certified aides have been treated shabbily for too long: The demands are daunting, the pay is poor, and burnout is endemic. The turnover rate for these jobs range upwards to 100 percent.
Worker safety is another reason. The Bureau of Labor Statistics says CNAs experience more injuries than any other occupation, including construction workers and firefighters.
“They have astronomical turnover rate,” says Milly Silva of 1199 SEIU, the union that represents nursing aides. “By the end of the day, they are completely drained because they are taking care of a dozen patients at a time. The only way to resolve it is by fixing the staffing shortage.”
With 44,000 disabled seniors living in our state’s nursing homes and the Baby Boom generation already into its 70s, that shortage is growing more acute. It’s time the Assembly decided whether the comfort of our elderly and the job safety of their caregivers are priorities for New Jersey.