Envisioning the Future for CNAs and Residents

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Lori Porter

Lori Porter, Co-Founder & CEO

National Association of Health Care Assistants (NAHCA)

I have spent 40 years working in long-term care services, first as a dishwasher, then to a certified nursing assistant (CNA), a certified medication tech, a certified activities director, a social services designee, and then a licensed nursing home administrator, all in the span of nine years. I am a high school dropout who grew up in the Ozarks of Missouri never dreaming I would amount to anything. Most of my teachers had told me that. Many of them have had to choke on their words years later, which brings me much satisfaction, although I am not sure that is the right way to feel. All bets were against me. Even my own mother, who thought I was the “be all end all” as a daughter, did not see me making much of myself.

In 1995, Lisa Sweet and I cofounded the National Association of Health Care Assistants (NAHCA) to recognize the position of CNAs as a real and recognized profession. We wanted to provide them with the type of resources we at NAHCA uniquely know they want and need and to find ways to increase the earnings they receive for caring for our nation’s most vulnerable citizens.

Covid-19 has been a dark storm for CNAs, but there is a silver lining. CNAs were initially unprotected with makeshift PPE and little to no hazard pay, while other professions took unemployment and earned an additional $600 per week. The average CNA does not even make $600 per week for their great sacrifices during 2020 and into 2021. CNAs have never had a professional win. We have heard 40 years of lip service about how important they are, but there has been no real change to improve their professional lives. To care so little for CNAs is to care very little about our elders in America.

Over the past 12 months, I have witnessed the pain and suffering of CNAs firsthand, and I have witnessed their incredible resilience. Many ask, “Why do they do it? Can they not get other jobs?” They do it because they need residents as much as residents need them. It is a two-way relationship, and both are dependent on the other. CNAs are fulfilled in knowing they make a difference in lives of those who can no longer care for themselves. There is no professional more committed to person-centered care than a dedicated CNA. Pay is an issue, but most CNAs want help. The want more CNAs because they know person-centered care is not possible without CNAs to practice it. There is nothing person-centered about having only one CNA for 30 or more residents.

Based on reports I receive daily from CNAs across the country, nursing home residents sometimes go with little or no touch in any given shift. That is both a wake-up call and a referendum on reforming our long-term care system for elders. The model of the past 40 years has not proven successful and reforming our workforce ecosystem is a must. Over the past 20 years, CNA staffing has only gotten worse. Providing person-centered care hinges on residents having professional CNAs in the numbers necessary to meet their emotional, physical, and psychosocial needs and provide care. That was not happening prior to COVID and certainly is not happening now.

My vision for the future hinges on collaboration with Pioneer Network and other organizations who are dedicated to quality care in our nation’s nursing homes. As we continue to face these challenges, NAHCA and Pioneer Network are dedicated to developing and advancing education and resources to ensure we are constantly valuing CNAs as one of the most important positions in long term care.

Nursing homes must change. We can lead that change when like-minded organizations come together. We must be stalwart in our commitment to changingness MUST BE RESPECTED BEYOND A COLD PIZZA PARTY!

20 comments on “Envisioning the Future for CNAs and Residents

  1. Joan Devine on

    I am glad you found us! To subscribe to our newsletter, go to the bottom of the home page and you will see a place to click to join the email list.

  2. Donna K Woodward on

    Lori, all I can say (after “WOW!”) is thank you thank you for your efforts on behalf of CNAs. CNAs are the key to quality care for LTC residents, yet in most ways they are at the bottom of the ladder in terms of having authority and receiving true respect, all those “Heroes Work Here” signs notwithstanding. Nearly every aide I’ve worked with has had to work two jobs just to make ends meet and are thrilled to get a double shift doing this back-breaking work.

    The future I’d like to envision for aides—and for the residents they care for—is one in which they work in an adequately staffed community and receive at least a living wage. We cannot provide person-centered care without the persons! (Duh. )

    Recently a journalist quoted a remarkJoe Biden made: “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.” Show us the money! Show residents, families, and staff what comes in and where it goes. Until LTC owners are transparent about their budgets, we won’t really know what they most valu, and where aides fit in their value systems. (And by extension, where residents’ quality of life fits in.) 
 I am really looking forward to hearing you on the 24th, Lori.

    • Lori Porter on

      Donna, all I can say is thank you! You get it…..However, the only way to make a healthy profit owning nursing homes is to cheat the residents and the staff. No one cares what the corporations who owns McDonalds makes. There has to be a way forward that recognizes good providers (who still believe there is not enough paid to care for our residents). Until we define what an elder is worth in our society I do not see a real solution to ensure person centered care is more than an illusion and so much more than removing a nursing station and opening dining. When DON’s are bonused for being under budget in medical supplies we know the best supplies/supports are not being provided. “REFORM LONG TERM CARE FOR ALL. “

    • Chris Wolf on

      Lori thank you for your words and efforts in continuing the fight for improving the image of our CNAs and the quality of work they provide. Their pay needs to increase as does the resident to staff ratio. I am a retired administrator. I truly. Believe it is all about reimbursement rates being to low. I wish you all the best in your efforts to help these problems

  3. Anne Ellett, R.N., N.P. on

    As we look to transform culture for residents in LTC, we can also reimagine and transform the role of the CNA. They have the relationships with the residents, and the best care will come from honoring and listening to the CNA’s. Let’s be sure they have a seat at the table!

    • Linda on

      Awesome. I work as a Staff Educator in skilled nursing facility. I to was a CNA and then became a nurse. I have worked in acute care, home care but love long term care. I value the CNA role they are the meat and potatoes of the organization. They have empathy and so much to offer and give to our residents each and every day. Kudos to all CNA”s

  4. Gwendolyn Monangai on

    Thank you Lori for your insightful and pointed remarks. I worked as a CNA while in college. What I made back in the 80s is still just about what people make today in these jobs.
    It is atrocious and it confirms exactly how and what we as a society think of our elders. It is not lost upon me either (and you and many likeminded people) that most of these jobs are done by women and women of color at that. CNA pay is at the intersection of ageism, sexism, racism.
    To bring a solution to the historically low wages of CNAs, we must confront these social issues head on. We can no longer side step them.
    If we want CNA to be a profession, then we must pay them as such.
    Thank you for your leadership on this.

  5. Susan Garces on

    We need to support those who have been physically or emotionally disabled by elders who have dementia. They deserve so much more paid days off and vacation time.

    • Joan Devine on

      I agree, Susan, we need to support those who are injured, but we also need to be proactive in providing the necessary training and sufficient staffing so that all staff, as well as family members, have a better understanding of how to support individuals living with dementia.

  6. Anne-Marie Louissaint on

    All I have to say to this Lori is Amen! I too started out as a CNA and worked my way to become an Administrator. I make sure to dote on my CNAs every day! They spend the most time with our residents during the day and I believe in the trickle down effect. When I became an Administrator 8 months ago in the middle of covid I hit the ground running. I started advocating for my staff to receive affordable healthcare and significantly more money per hour. Six months later my vision was achieved, my staff saw both affordable insurance and a $3.00 per hour pay hike. We have to keep on caring about our staff and they will in turn provide excellent patient care.

    • Lori Porter on

      Anne, congratulations on being a new administrator and for fighting for your CNAs. WOW a $3.00 increase is wonderful. Thank you so much for all you do. It is hard to explain how you can become a 5 star nursing home with a 2 star staff rating. I had a cost reporting accountant tell me there is no correlation between clinical outcomes and staffing. If I am a 5 star center with a 2 star staff what is my need to invest in them, is what we hear most often from providers. Keep caring and sharing we need more administrators like you fighting for their CNAs. Thank you.

    • Karen Cassidy on

      I have been a CNA for 11 years. The last 2 working in covid units to help feed my family. I fully support your cause and would like to know how I can join your plight? How can we change these conditions at the polls? How can we have some type of support system or education programs for CNA s? I have been working agencies just to make a little more money and the work its still back breaking with staff storage. If we band together at could be such a rewarding career for the can and heartbroken families.
      Karen Cassidy

      • Joan Devine on

        Thank you for reaching out, and more importantly, for the work that you are doing – for being there everyday to serve as a care partner to residents. Pioneer Network agrees that if we are to see the changes that we know need to happen, we need to work together, and we hope you will continue to follow Pioneer Network. I would recommend that you check out NAHCA, a professional organization of and for CNAs. They are doing great work in the area of advocacy as well as providing support for CNAs.

  7. Jay White on

    Amen. The Longevity Project for a Greater Richmond in Central Virginia has been working to also find partners in an effort to honor and support CNA’s and PCA’s. I would hope that we could also add Personal Care Aide’s to this list of unsung heroines and heroes.


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