Nursing Aides, Home Health Aides, and Related Health Care Occupations -- National and Local Workforce Shortages and Associated Data Needs

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Chapter 1. Project Overview | Chapter 2. Paraprofessional Workforce Supply and Demand | Chapter 3. Important Data Issues | Chapter 4. Existing National Data Sources | Chapter 5. State-Level Data Issues | Chapter 6. Occupation and Industry Classification Systems | Chapter 7. Current Data Collection Practice: CNA Registries | Chapter 8. Conclusions | Appendix A. Project Advisory Committee | Appendix B. Proposed State Data Collection Instrument | Appendix C. Occupational and Industry Definitions | Appendix D. Sample Data | Appendix E. Issues from Four States | Appendix F. CNA Registry Details | Appendix G. Annotated Bibliography | Appendix H. References

¹ Alzheimer's and related diseases affect approximately 11 percent of individuals 65 and older and nearly 48 percent of those over 85 years of age.

² "Acuity" is a term used to quantify a patient's level of illness or disability and, thus, his or her intensity of need.

³ The HealthCare Market Groups of Houston reported that share prices of long-term care and assisted living providers dropped by more than 69 percent during 1999 (compared to the Dow Jones average increase of 25 percent). In January 2000, the Phoenix Lending Survey of Philadelphia revealed that 85 percent of commercial lenders surveyed would not invest in the health care industry, the highest negative rating any industry has received since the survey was first performed in 1995.

⁴ Given the very low population and labor force growth projected over the next several decades, a normal business cycle recession will likely result in only a modest increase in the number of unemployed. Dr. Richard Judy, director of the Hudson Center for Workforce Development, suggests that the United States over the next 20 years can expect unemployment rates to vary only within the narrow range of a low of 3.5 percent to a high of 6.5 percent. See testimony of Richard W. Judy to the Subcommittee on Oversight and Investigation, Committee on Education and the Workforce, U.S. House of Representatives, February 17, 2000. Hudson Institute, Indianapolis, Indiana. http://www.hudson.org

⁵ This section owes much to the analysis of Dr. Lynn C. Burbridge found in "The Labor Market for Home Care Workers: Demand, Supply and Institutional Barriers," The Gerontologist, Vol. 33, No. 1, 1993 and to the analysis of Dr. Dorie Seavey found in An Industry Study of Services for People with Mental Retardation and Severe Mental Illness in Massachusetts: The Client/Consumer, the Workforce, the Providers, and the State, Special Report CRW21, Wellesley, MA: Center for Research on Women, Wellesley College, March 1999.

⁶ Note also that those who remain on public assistance after welfare reform are now more likely to have multiple barriers to employment—e.g., substance abuse, physical or mental disabilities, or other barriers which may preclude their employment in direct care jobs.

⁷ The U.S. Census Bureau assumes that immigration will decrease slightly between 1999 and 2010, from 1.236 million to 1.036 million, while emigration will increase slightly, from 282,000 to 322,000, over the same period. The overall change is modest—from a net migration of 954,000 in 1999 to 713,000 in 2010—although important since a significant proportion of net population growth over the projected period will be attributable to international migration. See Frederick W. Hollmann, Tammy J, Mulder, and Jeffrey E. Kallan (January 2000) Methodology and Assumptions for the Population Projections of the United States: 1999 to 2100, Population Division Working Paper No. 38, Washington, DC: Population Division, Bureau of the Census, U.S. Dept. of Commerce.

⁸ Pace, On Lok Senior Health, www.onlok.org/pace.html

⁹ What Is Home Care? New York State Association of Health Care Providers, Inc., http://www.nyshcp.org

¹⁰ Facts on Aging: Assisted Living and Shared Housing, Illinois Department on Aging, p.1, http://www.state.il.us/aging

¹¹About Assisted Living, National Center for Assisted Living, p. 1, http://www.ncal.org

¹² State of California – Health and Human Services Agency, Department of Social Services, Community Care Licensing Division, http://ccld.ca.gov/docs/attachments/0501adultelderlystats.pdf

¹³ State Assisted living Policy: 1998 Section III, Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services , http://aspe.hhs.gov/daltcp/reports/98state.htm, p. 16,

¹⁴ Facts on Aging, p. 1.

¹⁵ Illinois Association of Adult Day Care Providers, Illinois Department on Aging, http://www.state.il.us/aging

¹⁶ Illinois Department on Aging, In-Home Care, http://www.state.il.us/aging/1athome/ccp.htm.

¹⁷ State Assisted Living Policy: 1998 Section III, p. 102.

¹⁸ New York State Office for the Aging, http://aging.state.ny.us

¹⁹ Wyoming Department of Health, Aging Division, http://wdhfs.state.wy.us/aging/providers/institutions.htm

²⁰ Provisions Respecting Inapplicability and Waiver of Certain Requirements of This Title, Social Security Administration, Title XIX, Social Security Act, http://www.ssa.gov/OP_Home/ssact/title19/1915.htm.

²¹ The Policy Book, AARP Public Policies 2001, Chapter 7 Long-Term Care, p. 19, www.aarp.org

²² New York State Health Rules and Regulations, NYCRR Title 10, Section 415.26, http://w3.health.state.ny.us/.

²³ New York State Health Rules & Regulations, NYCRR Title 10, 415.26 (6).

²⁴ Regulations of the State of Wyoming, Chapter VIII Section 2, http://nursing.state.wy.us/ .

²⁵ Regulations of the State of Wyoming, Chapter VIII, Section 3.

²⁶ In Home Support Services, California Advocates for Nursing Home Reform, p. 1. http://www.canhr.org/publications/factsheets/fs_ihss.htm .

²⁷ California Advocates for Nursing Home Reform, p. 1.

²⁸ California Advocates for Nursing Home Reform, p. 1.

²⁹ 2001 California Supplement, Long-Term Care Credit, http://www.taxcpe.com/pdfs/casupp.pdf, pp. 6-9.

³⁰ The Paraprofessional Healthcare Institute, http://www.paraprofessional.org

³¹ Home Care Aide Association of America, http://www.nahc.org/HCA/home.html

³² Home Care Aide Association of America.

³³ Allen K, Long-Term Care: Implications of Supreme Court’s Olmstead Decision Are Still Unfolding, GAO-01-1167T, September 24, 2001, p. 9

³⁴ Stone, p. 13

³⁵ State Study Shows Progress on Long-Term Care, Points to Lag in Federal Health Care Initiatives, The Alzheimer’s Association, http://www.alz.org/media/news/1999/Pplongterm_care.htm( website accessed 2001, no longer available at www.alz.org.)

³⁶ The Family Caregiver Alliance, National Center on Care giving, Survey of Fifteen States’ Caregiver Support Programs, http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=457 p. 2. (website accessed 2001, publication no longer available on web, hard copy may be ordered.)

³⁷ The Family Caregiver Alliance, p. 6.

³⁸ Aging With Dignity, Governor’s Budget Summary, Department of Finance, State of California, http://www.dof.ca.gov/HTML/BUDGT00-01/Aging-N.htm

³⁹ Minority Staff Special Investigations Division, Committee on Government Reform, U.S. House of Representatives, Nursing Home Staffing Levels Are Inadequate in Chicago, January 16, 2001, http://www.house.gov/reform/min/pdfs/pdf_inves/pdf_nursing_staff_IL_rep.pdf, p. 1.

⁴⁰ Assisted Living in New York: Preparing for the Future, Report to the Governor and the Legislature, May 1999, New York State Department of Health, Office of Continuing Care, http://www.health.state.ny.us/nysdoh/alra/main.htm.

⁴¹ New York State Office for Aging, Project 2015, http://aging.state.ny.us/explore/project2015/index.htm .

⁴² Health Regulations Certification Nurse Aide Abuse Registry, http://www.scdhec.net/hr/cert/hrnar.htm

⁴³ Excerpts from Title 63 of the Oklahoma Statutes, Oklahoma Law on Nurse Aides, Certification and the Nurse Aide Registry, Oklahoma State Department of Health, http://www.health.state.ok.us/program/nrsaid.

⁴⁴ Center for Consumer Health Care Information, New York State Department of Health, Nurse Aide Registry, http://www.health.state.ny.us/nysdoh/healthinfo/webnuraid.htm .

⁴⁵ Harrington C et. al., 1997 State Data Book on Long-Term Care Program and Market Characteristics, Department of Social and Behavioral Sciences, University of California, San Francisco and the Department of Health Services Organization and Policy of the College of health professions, Wichita State University, Wichita, KS, May 1999, p. 15.

⁴⁶ Code of Federal Regulation, Title 42, Chapter IV Centers for Medicare Me dicaid Services , Department of Health and Human Services, Volume 3, parts 430 to end, National Archives and Records Administration, http://www.access.gpo.gov/nara/cfr/waisidx_01/42cfrv3_01.html.

⁴⁷ Assessment Systems, Inc. is a private for profit business that specializes in assistance with establishment and maintenance of nurse aide registries and in providing testing for nurse aide competency. The company provides services to state regulatory agencies and national associations. ASI develops and administers standardized examinations used in the certification and licensing of occupations and professions. http://www.asisvcs.com

⁴⁸ Massachusetts Nurse Aide Registry Program Mission Statement, http://www.state.ma.us/dph/dhcq/nar.htm .

⁴⁹ California Fieldwork, Center for California Health Workforce Studies, appendix to this report, p. 16.

⁵⁰ Indiana Code Title 16, Article 27, Chapter 1.5-1, http://www.in.gov/legislative/ic/code/title16/ar27/ch1.5.html.

⁵¹ Indiana Code, Title 16, Article 28, Chapter 13-1, http://www.in.gov/legislative/ic/code/title16/ar28/ch13.html

⁵² Interview with Lesa Roberts, Director, Health Occupations Credentialing, State of Kansas, September 19, 2001.

⁵³ Nebraska Department of Health and Human Services Regulation and Licensure, http://www.hhs.state.ne.us

⁵⁴ Title 10, Maryland Department of Health and Mental Hygiene, Subtitle 39, Board of Nursing, Certified Nursing Assistants, http://www.dhmh.state.md.us/mbn/cna

⁵⁵ The Maryland Nurse Aide Program, Assessment Systems, Inc., http://www.asisvcs.com/topnav/profiles/pdf/0721.pdf

⁵⁶ Chapter 144A.61, Subdivision 2, Nursing Assistants, Minnesota Statutes, http://www.revisor.leg.state.mn.us/stats/144A/61.html

⁵⁷ Nursing Assistant, Training, Competency Evaluation and Eligibility, Department of Health, State of Minnesota, http://www.health.state.mn.us/divs/fpc/profinfo/ib99_13.htm

⁵⁸ Title 63 of the Oklahoma Statues (63-1-1950.1), Oklahoma State Department of Health, Nurses Aide Registry, http://www.health.state.ok.us/program/nrsaid.

⁵⁹ Health Professions Regulation, Nursing Assistant Advisory Board, Rhode Island Department of Health, p. 1, http://healthri.org/hsr/professions.

⁶⁰ Nursing Assistant Training & Certification Program, Arkansas Medicaid Office of Long-Term Care, http://www.medicaid.state.ar.us/general/units/oltc/restrict.htm

⁶¹ North Carolina Department of Health and Human Services Division of Facility Services, Nurse Aide I FAQ, http://www.ncnar.org/faq.html.

⁶³ Health Care Personnel Registry Section, p. 1.

⁶⁴ Title 172 Chapter 96 004, Nebraska Department of Health and Human Services Regulation and Licensure, http://www.state.ne.us/home/SOS/hhs/t172-96.pdf.

⁶⁵ North Dakota Administrative Regulations, Article 54-07 Chapter 01, North Dakota Board of Nursing, http://www.ndbon.org.

⁶⁶ Texas State Senate Bill 1245, Chapter 48, Human Resources Code, Texas State Legislature Online, http://www.capitol.state.tx.us, p. 6.

⁶⁸ Code of Federal Regulation, 42 C.F.R.483.146 (b)(3).

⁶⁹ Boen JL, Who will take care of us? Shortage of nursing assistants worries elder-care providers, The Fort Wayne News Sentinel, October 18, 2000.

⁷⁰ Kinson M, New Hampshire Licenses Nursing Assistants, Insight, Volume 6 Number 1, 1997, p. 1, http://www.ncsbn.org.

⁷¹ Kinson, p. 2.

⁷³ See North Carolina Division of Facility Services, http:// facility-services.state.nc.us, Cecil G. Sheps Center for Health Services Research, http://www.shepscenter.unc.edu, North Caroli na Institute on Aging, http://www.aging.unc.edu.

⁷⁴ North Carolina Division of Facility Services , http://facility-services.state.nc.us/careerna.pdf.

⁷⁵ Appendix , Wyoming Long-Term Care Paraprofessionals, p. 1, p. 8.

⁷⁶ Comparing State Efforts to Address the Recruitment and Retention of Nurse Aide and Other Paraprofessional Aide Workers, North Carolina Division of Facility Services, September 1999, p. 3.

⁷⁸ The Iowa Nurse Aide Registry Online, http://www.dia-hfd.state.ia.us/nurseaides/ .

⁷⁹ State of Illinois, Nurse Aide Registry, http://app.idph.state.il.us/nar/index.htm .

⁸⁰ 2001 Florida Statutes, Title XXXII, Chapter 464, http://www.leg.state.fl.us/Statute.

⁸¹ Background Screening and Exemption Application, The Florida Department of Health, http://www.doh.state.fl.us/mqa/cna/cna_screening.html .

⁸² Criminal History Systems Board, General Information, The Commonwealth of Massachusetts, http://www.state.ma.us/chsb/cori/cori_cert.html

⁸³ Employee Disqualification List, Missouri Department of Health and Senior Services, State of Missouri, http://www.dhss.state.mo.us/Senior_Services/edl.htm

⁸⁴ Chapter 660, Section 315, Missouri Revised Statutes, http://www.moga.state.mo.us/STATUTES/c600-699/6600000315.HTM

⁸⁵ Pennsylvania Department of Health, Nurse Aide Registry, http://www.health.state.pa.us.

⁸⁷ Wisconsin Nurse Aide Program -Introduction , http://www.dhfs.state.wi.us/caregiver/NATD/NATDintro.htm.

⁸⁸ Reichard R, Testimony to the U.S. Senate Special Committee on Aging Representing The American Association of Homes and Services for the Aging, p. 3, http://aging.senate.gov/events/hr25rr.htm

⁹⁰ Certified Nurse Aide Registry, State of Indiana, http://www.in.gov/isdh/regsvcs/acc/certhha/index.htm

⁹¹ New Mexico Nurse Aide Registry, http://www.health.state.nm.us/dhi/NAR.htm

⁹³ New York State Department of Health, Center for Consumer Healthcare Information, Nurse Aide Registry, http://www.health.state.ny.us/nysdoh/healthinfo/nuraidreg.htm.

⁹⁴ Kansas Statute Chapter 65, Article 68, Kansas Legislative Services, http://www.accesskansas.org/legislative/statutes/index.cgi and Letter from Kansas Department of Health and Environment, May 1, 2000.

⁹⁶ Kansas Health Occupations Credentialing, p. 1.