Fewer nursing homes are offering training and certification programs for certified nursing assistants (CNAs), forcing aspiring CNAs to acquire outside training, often at their own expense, according to a report published by The Gerontologist.

In 2007, CNA training and certification programs were offered in just 24.4 percent of nursing homes containing 20 beds or more, the report shows, down from 37.6 percent a decade before. This means that more nursing assistants are receiving training in community colleges, high schools, vocational technical schools, and proprietary training facilities.

The report, written by members of Brown University’s Center for Gerontology and Health Care Research, analyzed nursing home administrative data for more than 15,000 nursing homes throughout the contiguous 48 states. It also used data from the National Nursing Assistant Survey (NNAS) to determine where CNAs are receiving their training and who is paying for it.

Who’s Paying for Training?

A much higher proportion of CNAs trained outside nursing homes are paying their own training costs. For example, more than half (51.3 percent) of CNAs trained in community colleges paid for their entire training.

The authors of the Gerontologist report write that CNA training outside of nursing homes can cost as much as $1500.

“This seems an unfair burden for CNAs who will go on to relatively low wage jobs,” says Denise Tyler, Ph.D., a co-author of the paper.

In sharp contrast, over 80 percent of CNAs trained in nursing homes paid none of their training costs, according to the NNAS. Training programs offered in nursing homes are reimbursable under state Medicaid programs, although at less than full cost in most states. More than four in ten CNAs receive their training in nursing homes.

Recruitment, Monitoring, and Training Quality Are Issues

Because CNA training is shifting away from nursing homes and into expensive outside settings, employers will have an increasingly difficult time recruiting new workers, the report states. Recruitment of CNAs — who provide 80 to 90 percent of care in nursing homes — is already a significant problem in the direct-care field.

“Allowing the cost of training to become a barrier for individuals who would like to work as nursing aides in long-term care facilities makes no sense given the recruitment needs of these facilities,” said Dorie Seavey, director of policy research at PHI.

An additional concern is whether the quality of training offered outside of nursing homes is lower than that provided in the homes. While more research is needed, the authors find that “[t]he few studies that have examined this issue suggest that this may be the case.”

The authors further note that states will have a more difficult time monitoring the quality of the training programs now that they are being scattered throughout the state.

– by Matthew Ozga