Boots & Sabers

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1025, 27 Nov 19

Evers’ veto harms state’s most vulnerable citizens

My column for the Washington County Daily News is online. Here’s the whole thing.

The booming economy and low unemployment rate are causing worker shortages in several areas of the workforce. One of those areas is a severe shortage of certified nursing assistants. The Republicans in the Legislature tried to help ease the shortage with a common-sense bill, but the Democrats opposed it every step of the way, culminating with Gov. Tony Evers vetoing the entire bill. The impact of that veto will be most painfully felt by the most vulnerable among us.

Anyone who has ever had to spend any time in a hospital or a long-term care facility knows what CNAs do. CNAs provide the intimate, critically important personal care that is necessary before all other health care can be performed. They bathe patients, check vital signs, change bedpans, clean up vomit, help patients use the toilet, dress people, dress wounds, feed patients, and so many other important tasks.

For people in long-term care facilities, CNAs are their lifeline. Elderly and disabled patients rely on CNAs throughout every day to help them do the things that they can no longer do for themselves. These are the people who are most impacted by the shortage of CNAs as longterm care facilities close across Wisconsin and the remaining ones are chronically short of staff.

The reasons for the shortage of CNAs are relatively straightforward. CNA work is hard. Much of it is also kind of gross. The average wage for a CNA is $13.58 per hour according to Glassdoor. In order to become a CNA in Wisconsin, you must pay for 120 hours of training, including 32 hours of clinical experience, and pass the exam. When unemployment in Wisconsin is 3.2% and fast food restaurants and retail stores are paying $15 per hour for employees with no experience, CNA work is not very attractive by comparison.

Because of this, many CNAs are either nurses or doctors in training. Working as a CNA provides these students ground floor experience in health care and the ability to make connections that could aid their career. They are willing to pay for the training and work for the lower wages because it is a stepping stone in their careers.

When there is a labor shortage, the normal market response is to increase wages to attract more workers. A major distortion to the labor market for CNAs is that many of the jobs are supported by Medicare and Medicaid. Both of those government programs chronically underfund the actual expenses, forcing health care providers to supplement expenses from other patients. Private health care facilities can manage, but many long-term care facilities rely on Medicaid and Medicare as their primary funding source. In short, there just is not enough money to raise wages substantially.

In light of the CNA shortage and the relative inelasticity of wages, the Republicans in the Legislature passed a bill to try to increase the number of available CNAs from other states. The bill was simple. Federal rules require that a CNA receive 75 hours of training with 16 hours of clinical experience. Wisconsin requires 120 hours of training with 32 hours of clinical experience. The bill that the Republicans in the Legislature passed would have allowed CNAs who meet the federal standard to work in Wisconsin.

Twenty other states use the federal standard including the neighboring states of Minnesota, Iowa, and Michigan. There is no evidence that the additional 45 hours of training that Wisconsin requires has any appreciable impact on the quality of care. Not having enough CNAs in a facility to do the work definitely has a negative impact on the quality of care. By allowing CNAs who meet the federal standard to work in Wisconsin, it would have immediately increased the number of CNAs available — especially in areas near the western and northern borders.

Last week, Governor Evers vetoed the bill in its entirety. In his veto message, Evers said, “I object to providing less training for those who care for our state’s most vulnerable citizens,” despite any evidence that adopting the federal standard will harm care. One thing is certain: The quality of care is zero if nobody is available to provide the care.

While pronouncing concern for our state’s most vulnerable citizens, Governor Evers’ veto will harm them the most.


1025, 27 November 2019

1 Comment

  1. Mar

    One thing I would disagree with is that many CNAs become CNAs to move up to nurses or even doctors.
    From my experience, i have never met a CNA who went on to med school. I’m sure it happens but it is very rare.
    As far as going on to be a nurse, some do, but the vast majority do not, especially now days. The two jobs are totally different. An RN’s is almost all computer work, while the CNA is almost always hands on work. It didn’t used to be that way but now days, the RN is tied to the computer in almost everything and the CNA does the hands on work. And most CNAs would rather be hands on than tied to the computer.

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