Nursing homes racing to certify hundreds of temporary nurse aides ahead of an Oct. 7 deadline may have some additional time to do so.

The updated Centers for Medicare & Medicaid Services (CMS) guidance, issued on Monday and first reported by Bloomberg Law, provides opportunities for individual facility and statewide or county waivers when barriers to testing and training are apparent.

Those who wish to request a waiver must provide documentation that includes evidence that TNAs were either enrolled or signed up for training or testing, but were unable to be accommodated by that geographic area’s Nurse Aide Training and Competency Evaluation Program (NATCEP).

The location-based or facility specific waivers will only last as long as the public health emergency (PHE) remains in place, according to CMS. The goal is to grant the waivers for “as short as possible” a time period.

While the PHE is set to expire on Oct. 15, nursing home industry officials are fairly confident Health and Human Services (HHS) Secretary Xavier Becerra will extend it an additional 90 days.

Providers and industry trade groups were both relieved and encouraged to receive the news, as the availability for the testing TNAs need to be certified continues to be hard to come by in a timely manner.

Karen Maselli, assistant vice president of operations at ProMedica Senior Care, welcomes the opportunity and plans to consider doing so for markets where it is needed.

ProMedica Senior Care has approximately 660 skilled nursing TNAs who need to be tested to become certified.

“This would allow us to continue to employ staff members as TNAs who have proven their dedication to the patients in our care and the residents who live with us. Generally, for the industry, we can continue to employ individuals in our communities who otherwise seek employment outside of the skilled nursing sector,” Maselli said.

The Covid-related waiver had allowed TNAs to work on the front lines longer than the federally mandated four months before taking a state exam.

As recently as just a few months ago, shortly after CMS first announced its decision to sunset certain waivers associated with the PHE, the government agency’s leadership stressed the need to “get back to normal operations” and restore “minimum protections” to the nursing home setting.

As of June 7, that four-month cutoff was restored. Anyone hired prior to that date would have until Oct. 7 to meet testing requirements, CMS had said.

CMS had cited long-term care survey findings that linked resident weight loss, depression and pressure ulcers to the “lack of certain minimum standards” as one reason why the waiver was coming to an end, according to an earlier memo issued by the agency.

‘A welcome starting point’

Some skilled nursing operators also see the move as a jumping off point to continuing the conversation with the federal government and other stakeholders to help find solutions to the workforce shortage.

“It’s a welcome starting point in creating solutions to the workforce crisis we are facing, and in context a commonsense approach from CMS,” said Steve LaForte, director of corporate affairs & general counsel for Cascadia Healthcare. “The workforce shortage … show no signs of materially abating, and so this gives us avenues to continue to create workforce opportunities through a defined process that has created partial solutions over the pandemic period.”

Eagle, Idaho-based Cascadia has already initiated the waiver process at many of its skilled nursing facilities, LaForte said.

Having extra time to certify TNAs so they can become CNAs has become especially important with a proposed federal staffing minimum in the rearview.

The nursing home sector has lost nearly 229,000 caregivers nationally since February 2020, according to Bureau of Labor Statistics (BLS) data.

The study is focused specifically on registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs), according to Abt Associates Principal Alan White, the research firm contracted by CMS to study the issue.

A short-term solution to a potentially long-term problem

While considered a small victory in the overall staffing shortage fight, the sector’s trade associations remain concerned the TNA testing backlogs and lack of availability could spill over long past the end of the PHE.

“We appreciate CMS recognizing that temporary nurse aides should have a more realistic opportunity to get certified as a next step on their long term care career path. However, the concern remains that nationwide training and testing backlogs could extend well beyond the public health emergency — perhaps even for years — which ultimately, will restrict professional advancement opportunities for these heroic caregivers,” said Holly Harmon, AHCA/NCAL’s senior vice president of quality, regulatory & clinical services.

It could also result in resident care disruption, Harmon added in a statement.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (NAHCA), said the additional waivers is an important recognition by CMS of the ongoing workforce crisis in long-term care, but hopes the federal government uses this as a stepping stone to making it easier to recruit, train and keep CNAs long-term.

“NICE and NAHCA hope that CMS will continue to address barriers that exist to recruitment, training, and retention of CNAs by making it more accessible, such as through online training and other virtual opportunities,” Porter said.

Janine Finck-Boyle, vice president of health policy at LeadingAge said while the organization is relieved for its members, this is just one step forward and much more needs to be done.

“Chronic underinvestment in and longstanding disregard for aging services—and primarily the valuable workers who are its core—created an opportunity for COVID to wreak havoc,” Finck-Boyle said in a statement. “This is not a CMS-only issue. We need all parts of government to work together to ensure every older adult and their family can access the care and services they need.”

There does appear to be some attention at the congressional level on the issue, at least in the form of proposed legislation.

The Building America’s Health Care Workforce Act would give TNAs an additional 24 months following the end of the COVID-19 public health emergency to complete testing.

TNAs would also be able to apply their on-the-job experience and training toward the 75-hour federal training requirement to become a CNA, which is currently allowed in some states, if the bill passed.

Despite its enthusiastic reception from industry leaders, the bill has yet to gain any traction.