Approximately one-third of the states require more than the federally mandated 75 hours of training for certified nursing assistants. Some states have sought to raise nursing home pay by increasing reimbursement levels and mandating that most or all of the increase be applied to workers' wages. Eighteen states have enacted such wage pass-through programs. The only state that maintains data on the impact of higher wages, Michigan, reported that turnover rates for certified nursing assistants declined from 74.5 percent in 1990 to 67.45 percent in 1998. Pass-throughs are clearly only part of a solution and don't directly address the quality of care.
Nursing homes suffer from interrelated problems that defy any one remedy.
Addressing all the major deficiencies will require sustained advocacy from coalitions representing several constituencies that historically haven't seen their interests as coinciding. Labor unions are central to such coalitions because they combine representation of workers with an ability to organize other constituencies and to press legislatively for higher standards and reimbursement levels. The group originally came together to advocate for increased staffing levels but soon realized the need to address factors causing high turnover first. Owing to the efforts of Barbara W. Frank, director of state health policy at the Paraprofessional Healthcare Institute, the diverse groups in CORE began to see how their interests overlapped. Initially, worker pay was not even on the radar screens of patient-advocacy organizations.