Lack of advancement is another reason many CNAs quit. Wolapaye followed a ladder: Dining Assistant led to Certified Nursing Assistant; then he earned a Med Tech certificate; then he began school to become a Licensed Practical Nurse, until his brother died, who was looking after his kids in Liberia. Wolapaye took on double shifts to pay for their education. His goal remains: Registered Nurse, who average $39 per hour in the U.S. His path to get there has been long and arduous, even as he’s had more advancement opportunity than many elder care workers.
Helping establish career ladders is one way federal and state governments can assist providers in retaining workers, says David Grabowski, professor of health care policy at Harvard Medical School. Providers like Goodwin Living are equipped to do this, in part, from private pay. But for others, like small providers who make up the majority of assisted living communities, he says the government should create roadmaps for partnering with community colleges that offer training programs, or incentives, or loan forgiveness for workers. “If cost is a big barrier here, which it is for many individuals in this workforce, we should completely invest in making [advancement training programs] free.”
The hardest position for providers to fill is often Registered Nurse. When a worker ascends from a nursing assistant to a nurse, it’s a “win-win,” says Grabowski, because the provider fills a role they need and the worker gains economic mobility. “Staffing shortages are taking up all the oxygen right now in the room in long-care,” he says, citing a “desperation” among providers, who are competing with each other for staff, with some offering ownership stakes and signing bonuses to new direct care workers. “Allowing someone to climb a career ladder” is a much better, more sustainable path, he says.
If there are no policy changes, America will be a country where its seniors do not live or die with dignity, says Woolhandler. The quality of care will deteriorate: fewer baths, fewer people to prepare food or help with toileting. An understaffed, demoralized workforce leads to more disease transmission, she notes. More seniors will be bedridden; there will be more falls, when people do try to move about, with some discovered days later.
As Wolapaye continued working the Hot Zone, General’s symptoms worsened, and he was sent to the hospital. Soon afterwards, Wolapaye called General’s wife to check on her. She was a night owl, surfing TV channels, and they’d developed a friendship. He raised the bed head to make her comfortable. The next day, he knocked on her door, and she tried to turn her head in his direction. He reported to the nurse that something was wrong. The next evening, she was sent to the hospital.
As the virus worsened, some staff at Goodwin Living declined to work, and those who did come in avoided Wolapaye and the others tending to the Hot Zone. They were trying to keep their families healthy and alive. But Wolapaye was trying to keep his family alive, too — that included General and his wife. “They were like my father and mother,” he told me.