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Cedar Rapids, Iowa 52401
DES MOINES — After a decade of rolling a boulder up the legislative hill, Di Findley isn’t about to give up on a bill this year to address the direct caregiver workforce.
“No, no, never,” the executive director of Iowa CareGivers said. “It’s too important to too many people.”
Iowa CareGivers, which advocates for direct caregivers and their clients, and groups representing seniors, Iowans with developmental disabilities and a variety of health care providers, has been working on legislation that would, among other things, expand the direct care workforce registry in the state Department of Inspections and Appeals. No one knows for certain how many people fall into that category, but Findley’s “best guesstimate” is somewhere between 40,000 and 65,000.
They are CNAs — certified nurse assistants — who help patients with daily living activities and other health care needs. They also are referred to as nurse assistants, patient care assistants or nurse’s aides.
“That’s part of the problem,” Findley said, “they have about 30 different titles.” Some describe the work they do, others the clients they serve and some have titles given by employers as perks.
House File 692 was written to address that problem by expanding the direct care workforce registry that now is limited to CNAs who work in nursing homes. There are thousands of other CNAs who provide in-home care or work in settings other than nursing homes, Findley said.
The lack of a comprehensive registry or database makes it hard for Iowans with disabilities, older Iowans and family caregivers “who are struggling to find people to help them in the home and in their own communities to remain as independent as they possibly can,” she said.
Nursing homes may be the largest employer of CNAs, but staffing shortages are a “chronic problem,” said Anthony Carroll, associate state director for advocacy for AARP Iowa. At the height of the coronavirus pandemic, an AARP report showed half of Iowa nursing homes had staffing shortages. The most recent reports show that 37 percent are short-handed. While COVID-19 increased the problem, Carroll said, 20 percent of nursing homes were reporting shortages even before the pandemic.
The pandemic has highlighted the need for employers needing to know who is available, where they’re available and what credentials they have, he said.
Nursing homes tend to do their own recruiting, “but the system is patchwork at best,” Carroll said. Many rely on temporary staffing agencies that “fill a need, but what’s our long-term plan?”
The proposed changes would include tracking caregivers’ credentials and training. Now, caregivers often have to retake training if they move from one job to another. That creates a hardship for the caregiver if he or she can’t work while retaking the training, “but also for employers because it takes time to onboard people,” Findley said.
Rep. Michael Bergan, R-Dorchester, who has been working on the legislation for three years, compared the proposed database with the state’s child care registry for people who provide services in homes and centers.
The lone group registered as opposed to the bill, ChildServe of Des Moines, believes the database would be too broad to be useful. ChildServe provides care to more than 4,500 children, mostly in Central Iowa and Iowa City. It offers services to children and young adults with developmental disabilities, acquired injuries and other health care needs through clinical, home- and community-based programs.
“For instance, (the bill) said something about consumer-directed care, which typically includes family and close friends,” said George Eichhorn, ChildServe’s legal counsel and a former legislator. That could make the registry too unwieldy to be helpful.
“It just looks like you'd end up with a database of a lot of people's friends and neighbors who only do it for one person or would only be a direct support professional for one family … but not looking for further employment,” Eichhorn said. He doesn’t see how that would help either caregivers or employers.
However, a change in the bill would make participation in the registry optional for those “informal” caregivers, Carroll said.
Although the bill has stalled again this year, Bergan called it progress that the bill won approval from a legislative committee — a first, according to Carroll.
Carroll, Findley and Eichhorn are encouraged by actions Inspection and Appeals has made to upgrade its webpage for employers to search for direct care workers.
“We believe it provides the framework upon which to carry out the work in our bill,” Findley said.
She plans to visit with the agency about what next steps it might be planning and whether it will request funds from the American Rescue Plan — the latest federal stimulus plan — to continue its updates.
CareGivers also is concerned that some people, including lawmakers, may perceive those changes as solving the problem.
“It is great foundational work, but it does not include the expansion or public portal,” Findley said. “Without the legislation there are no assurances of that.”
Bergan hopes a sponsor for a Senate companion bill can be found to move the process forward next year in the Legislature.
“The staffing crisis not going away,” Carroll said. While the pandemic has heightened awareness of the deadly consequences of short-handed staffing in nursing homes, the lack of system to track the caregiver workforce has been a problem for years, especially for families and individuals who need help.
The goal now, he said, is to “translate awareness into pressure to pass this.”
“As long as we’re having the conversation of how, not whether, gives me hope,” Carroll said.
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