Workforce Issues in Long-Term Care

There are five major job categories in long-term care.

Certified nursing assistant (CNA). CNAs work under the supervision of the nursing staff, and provide 60 percent or more of the direct care to nursing home residents. CNAs assist residents with activities of daily living, such as eating, bathing, dressing, and transferring from bed to chair. They may provide skin care, take vital signs, and answer residents’ call lights, and are expected to monitor residents’ well-being and report significant changes to nurses.

Home health aides (HHA). HHAs carry out a number of tasks that are similar to those done by CNAs, but do so in an impaired individual’s home, under the supervision of a nurse.

Personal care aides (PCA). PCAs, who are not certified, provide patients with assistance in activities of daily living in their homes. Major tasks include feeding, dressing, and bathing.

Licensed practical (or vocational) nurses (LPN). LPNs must be supervised by a registered nurse, and primarily provide direct care after a training program of between twelve and eighteen months. LPNs often have some supervisory responsibility for CNAs in long-term care.

Registered nurses (RN). RNs can take several types of educational programs that may last different periods of time, but all graduates take the same licensing examination. Some RNs focus on direct care of residents, but most have supervisory responsibilities in the long-term care setting.

Because the major actor in the nursing home setting is the CNA, and because workforce problems center around this job category, this entry focuses most heavily on CNAs.