The Backbone of Long-Term Care: Working With Certified Nursing Assistants During COVID-19

By Shanna Howard

CERTIFIED NURSING ASSISTANTS (CNAs), sometimes called nurse aides, assist with the direct care of people under the supervision of a registered nurse (RN) or licensed vocational nurse (LVN). In a long-term care (LTC) facility, CNAs help residents bathe, dress, brush their teeth, use the toilet, eat meals, and other activities of daily living, while also obtaining vital signs and making observations. Due to this close and regular interaction, CNAs come to know LTC residents well and build close relationships with them.

“They are the backbone of long-term care,” says Kevin Gluch, RN, Director of Nursing at Westminster in Austin. “They are with the residents 24/7, assisting them with the most intimate levels of care. They are in a position to notice changes in the resident and bring those to the nurse’s attention.”

MEETING THE CHALLENGE

The COVID-19 outbreak introduced special challenges for residential care settings, like LTC, where residents may have compromising health conditions and infectious disease can spread quickly if not well managed. At the Legacy at Town Creek in Palestine, staff had to rapidly respond when a resident began to show symptoms of COVID-19. She exhibited a fever, sore throat, and headache. Following negative flu and strep tests and a chest X-ray showing prominent bronchial changes, a COVID-19 test was ordered and staff prepared to move the resident and her roommate into a recently established isolation unit. The resident primarily spoke Spanish, so Spanish-speaking CNA Audrey Cadena quickly stepped up to join the residents in isolation. Cadena and Director of Staff Development Jackie Shocklely, BSN, RN, focused on making the residents comfortable and safe, ensuring necessary supplies were available within the isolation unit and implementing standards to conserve personal protective equipment through extended wear and reuse. That night, two additional residents developed symptoms and joined the unit.

“Our two turned to four quickly, and Audrey never batted an eye,” says Shockley. “She went to work making everybody comfortable and getting them settled in for the night.” Thankfully, the tests were negative, but the value CNAs like Cadena provide in LTC is even more evident during a potential outbreak.

CARING IN A CRISIS

Across the nation, LTC facilities are implementing prevention methods for COVID-19, like wearing additional PPE. Unfortunately, safety precautions limit interaction. “Just by wearing masks, you affect a resident’s ability to see the nurse’s or CNA’s smiles and emotions,” says Gluch. Prevention has also required social distancing within the facility and limiting access to the facility. “Families can’t come either. And you can’t stand and have a conversation if you’re six feet apart. It’s changed how you have those conversations.”

Like hospital staff, LTC staff face concerns that going to work may mean becoming ill themselves or transmitting the virus to their families. While there is a good deal of attention on the risks nurses face in our current environment, the role of CNAs is less appreciated. Gluch and Shockley have witnessed their dedication to patients.

“With so much emotion and uncertainty surrounding COVID-19,” says Shockley, “I think the many selfless acts of our CNAs in long-term care facilities are being overlooked. They are truly the ones providing hands-on, face-to-face direct care.”

Shockley says that we need CNAs now more than ever. In Texas, the median CNA turnover rate was 67.4% in 2019. 1 Shockley endorses a movement to fast-track CNA training. “During these trying times, I believe our need today is as great as the need was in World War II when nurse aides proved to be priceless.” In fact, on March 30, 2020, the Centers for Medicare and Medicaid Services issued a waiver of certain requirements for the training and certification of nurse aides in nursing homes. 2

No matter how the pandemic progress, Shockley says, “The giving hearts of these CNAs will not be forgotten.”

REFERENCES

1. Texas Center for Nursing Workforce Studies. (2019). Long Term Care Nurse Staffing Study, Highlights and Recommendations. Texas Department of State Health Services.

2. Centers for Medicare and Medicaid Studies. (2020). COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Department of Health and Human Services.