March 2, 2022
Contact Deborah Pacyna 

CAHF Calls on State to Provide Living Wage for Nursing Home CNA

“Drive to 25” campaign seeks wage increases for certified nurse assistants

SACRAMENTO, CA March 2, 2022 - The California Association of Health Facilities is calling on the state to provide a living wage for certified nursing assistants (CNAs) who work in skilled nursing homes by 2025. The “Drive to 25” campaign is part of a series of reforms needed to deal with a crippling workforce shortage that is threatening access to skilled care in nursing homes.

CAHF is requesting that the Medi-Cal program establish a nursing home CNA minimum wage that will grow to $25 per hour in the next 3 years.

Fifty one percent of direct care staff, the backbone of care delivery in nursing homes, are eligible for public assistance according to a report by the California Labor and Workforce Development Agency.

“For too long skilled care workers have been overlooked, overworked and underpaid,” said CAHF CEO Craig Cornett. “This reform is focused 100 percent on strengthening and developing the nursing home caregiver workforce and will not enrich facility operators.”

Cornett noted almost 80 percent of the state’s direct care workforce is comprised of women. Fifty percent are immigrants, and many are single mothers. “A living wage will help workers, increase caregiver retention and benefit resident care,” he added.

The SNF Medi-Cal reimbursement level has never adequately provided for the sickest, poorest and often oldest Californians. The Medi-Cal program reimburses the average nursing home $250 a day to provide an individual 24 hours of care. By comparison, the state pays the average IHSS worker about $130 a day to cover one 8-hour shift to support an IHSS resident in their own home, without the delivery of any nursing care, meals, utilities or rent.

Skilled nursing facilities (SNFs) in California are almost 100 percent government funded, with most SNFs receiving approximately 66 percent of their funding from the Medi-Cal program (the remaining funding comes almost exclusively from Medicare). The government payments that SNFs receive provide funding for wages for nursing staff (RNs, LVNs, CNAs, etc.), wages for support staff (janitorial, housekeeping, food service, and office support), payment for operating expenses including utilities, supplies, food and rent to pay for resident housing costs.

Under the proposal, SNFs will pay a specified minimum wage with Medi-Cal covering the costs of approximately two thirds of the wage increases. The rest will be covered by facility funds. The Medi-Cal share of this cost will be funded as a direct pass-through from the state to facility employees. The new “CNA living wage” will not be discretionary, but required to be paid to all CNAs. 

Additional Reform Proposals
Enhanced Registered Nursing in Skilled Nursing Facilities
California currently recognizes the clinical value of a 24-hour RN, seven days a week, for larger nursing facilities (100 beds or more). Smaller buildings are required to have eight hours of RN coverage, seven days a week. Research supports higher RN coverage in smaller SNFs. CAHF proposes that the RN nursing coverage be at least doubled for smaller SNFs with 60-99 beds. The Medi-Cal program should be required to cover these costs as a new mandate over the next three years and provide incentives for SNFs to hire additional 24-hour RNs as soon as possible.

Workforce Investment in Skilled Nursing Facilities
The state must prioritize the recruitment and development of nursing facility staff. Before the pandemic, skilled nursing facilities were struggling to attract and retain qualified staff. In 2019, the then Office of Statewide Health Planning and Development (OSHPD) estimated the state would need 20,000 CNAs by 2030. COVID-19 further devastated the long-term care workforce and according in an analysis by the California Workforce Development Board, there will be a projected need of 20,000 CNAs by 2025, just to replace workers exiting the profession.

CAHF is requesting $150 million over a three-year period to build on the successful implementation of the HCAI CNA workforce training funds allocated in the 2021-22 State Budget. ($43 million). These funds should be used to support existing facility-based training programs, union led training programs, and expand partnerships with local Workforce Investment Boards, community colleges, adult programs and ROP programs that have historically coordinated training programs with local nursing facilities.

Study to Establish Appropriate Levels of Clinical Care
A growing body of evidence has shown that there is a strong relationship between the levels of clinical staffing and quality care for residents. However, the most frequently cited research calling for staffing ratios is more than 20 years old. In addition, much of the past research did not appropriately account for numerous changes that have occurred in care delivery in recent years, or lessons from the COVID-19 pandemic.

CAHF supports a two-year study to establish evidence-based standards for specific minimum care requirements during times of normal and emergency nursing home operations. A temporary workgroup should be convened, and the study finalized and presented to the state by 2024 to help inform the process of staffing improvements.