Commonwealth Magazine features Patrick Stapleton's Op-Ed about Sherrill House's creation of a new role: Senior CNA's

Nailing a rung into the nursing home career ladder
by Patrick Stapleton

AS RECENT NEWS HAS MADE CLEAR, nursing homes have a Medicaid reimbursement problem. What you may not have heard during the steady drumbeat of media coverage is that nursing homes also have a recruitment and retention problem. It is part and parcel of the reimbursement problem; but it is separate, too. 

Nursing homes depend on Certified Nursing Assistants (CNAs) to provide much of the care to our short-term rehabilitation patients as well as our long-term care residents. They are not the only staff – we have nurses, therapists, activities directors and others – but they are clearly the backbone.

 The math problem is that the industry has more CNA staff positions than people to fill them. This problem gets addressed by CNAs working multiple shifts in different facilities to maximize their pay, working much longer than a 40-hour work week, which is not ideal from a rest and wellness perspective. Also, staffing agencies provide temporary CNAs to fill open shifts, which costs facilities more and can disrupt continuity of care. 

 As I write this today, one in seven nursing home positions across the state is vacant and multiple closures have already occurred this year, in part due to the staff shortage. The use of agency staff to fill vacant shifts has tripled between 2015 and 2018 – just three years. 

 The logical questions any observer would ask are: Why aren’t the employees staying around? Is it the pay or benefits? Is the work too challenging? 

 One key reason for the retention problem with CNAs is that there is a huge gulf between the training to become a CNA (minimum 75 hours in Massachusetts) and the additional coursework and rotations needed to move up the ladder and become a nurse. CNAs often work double shifts to make ends meet, given that salaries are lower than they should be due to chronic underpayment by the state Medicaid program. Many simply don’t have the time to take the classes and study for the tests, even if they have the inclination to become a nurse. 

 If the career ladder represents an actual ladder, think about climbing the ladder with several consecutive rungs missing. That makes it awfully hard to get higher. 

 Our facility, Sherrill House, has developed one solution, by creating the new position of Senior CNA. The Senior CNA role gives the employee greater responsibility, seniority and choice of shifts, along with a higher wage. It not only incentivizes the employee to get to the next level and become a nurse, but the higher pay and better shifts make that long-term course of study possible. 

 We currently have four new Senior CNAs and they average 14 years of service at our center. They have responded enthusiastically to the new title and responsibilities. Moreover, the patient or resident can see they are getting care from a higher-level staff member. 

 We hope that we have not only set up these Senior CNAs for future study and training, but we have shown the rank-and-file CNAs that they have a future at Sherrill House; that they can grow in their role and earn higher wages, take on more responsibility, and avoid shifts that interrupt family time. We are, in essence, nailing a missing rung into the career ladder. 

 The result is that our retention rate far exceeds the state average and we are not continuously hiring staff to have a steady stream of CNA backfill, because we don’t need it. 



 We think our model, coupled with other industry-wide tools like scholarships, can serve to slow the revolving door that is CNA staffing, while ultimately decreasing reliance on temporary staff. That will be better for patients and residents as well as the facilities that care for them. 

Patrick J. Stapleton is the CEO of Sherrill House, a not-for-profit skilled nursing and rehabilitation center in the Jamaica Plain neighborhood of Boston.