Across the country, skilled nursing facilities are facing the worst direct-care staffing crisis in decades. Massachusetts, with an unemployment rate of 3.5 percent at the end of 2017, is among the states struggling to attract and retain sufficient numbers of frontline health workers, including certified nursing assistants (CNAs). With CNA vacancy rates having more than doubled since 2010, the insufficient staffing is affecting the ability of nursing facilities to deliver quality care to frail elders and individuals with disabilities.

This crisis is driven by three factors:

1. A rapidly growing older population in need of care,
2. The quality of nursing assistant jobs, and
3. Declining government funding for nursing facility care.

Improving job quality for CNAs requires a multi-pronged strategy, including improved compensation and better training and support; however poor supervision is frequent factor leading to high turnover. Multiple reports found that positive supervision can greatly increase direct care workers’ sense of value, job satisfaction, and intent to stay. Supervisors and managers who are trained to support staff and engage them in decision making, according to the IOM, demonstrate a higher level of care and concern resulting in higher retention rates.