What to Look for in Staff Training Part 1: Importance of Preparation

It makes sense to check out the décor before sending a loved one to a long term care (LTC) facility.   Maybe even try the food in the cafeteria, check the comfort level provided in the beds, observe the cleanliness of the bathrooms, and determine whether the lighting is appropriate. Yet the most important aspect of LTC does not come from the outward appearances but from the caregivers.

In nursing homes, these caregivers, commonly referred to as CNAs (Certified Nursing Assistants) can independently affect the quality of your loved-ones care. They are the individuals who monitor daily health, dress and undress, bathe, feed and clean up after residents. These direct care workers spend the most time with your family member.  Yet this highly stressful job comes with some of the lowest pay in the healthcare field, limited training, and very few tangible benefits.  It is no small wonder that CNAs and other LTC workers turnover at an alarming rate, sometimes at 100% per year, costing the industry $4.1 billion annually.(1,2)

For the consumer, staff retention and turnover rates might not register as the most important issue regarding LTC home placement. Even if the consumer is aware of the importance of CNA abilities, it still might be hard to look for the red flags. This paper will discuss what to look for in a LTC facility regarding an atmosphere of respect among the staff and expectations of training and competency.  Finally, consumers need to inquire about the staff retention and turnover, as these factors are related to the quality of care provided.(3)

About the Author: Debra Fox is the CEO of Fox Learning Systems and a long-time veteran of elder care staff training.  A former television anchor, Debra pioneered the use of interactive documentary techniques to improve training and elder care quality.


  1. Mary Forrest, C. B. (1990). Nursing Homes: The Complete Guide. New York : Facts on File.
  2. Nurse Aid Training. Washington : Department of Health and Human Services.
  3. Rosen, J., Mittal, V., Degenholtz, H., Castle, N., Mulsant, B. H., Hulland, S. et al. (2006b). Ability, Incentives, and Management Feedback: Organizational Change to Reduce Pressure Ulcers in a Nursing Home. Journal of the American Medical Directors Association, 7, 141-146.

  • http://www.safehavenseniorfamilyhome.com/ Katie

    This is so very true, and learned this first hand while my mother was in a Nursing Home and then an Assisted Living Home. I hate to say it, but her care was just awful and the CNA’s or others directly in that field were very disappointing to me, and I was always there to make sure she got the proper care, as it seemed when I was not there, her care was very inadequate.

    I do believe those that do stay with such pay have a gift for loving and appreciating elders, as well as respecting them. Many caregivers just think it is an easy paycheck, and it is not. I also learned this first hand when the lady I care for as a live in and supervisor for her 5 caregivers (she had 24/7) care, had several caregivers that were sent to us who were, as far as I was concerned, totally in the wrong field. During the short time I cared for Eileen, (91 year old elder lady, who died Oct. 24, 2008) I must have gone through 20 caregivers through the Agency, as I wanted to make sure she had the best care available. Thankfully, after 3 months, I did end up with the cream of the crop. These girls were wonderful and did such a wonderful job, even though they were paid very little from the Agency. They loved their job though as they loved and respected elders and wanted to be a part of Eileens life, which to them was part of their pay.

  • Kim

    When I did marketing for assisted living I always told my tours that the people who deserve all the kudos are the home health staff and the dining room staff. They have incredibly demanding, physical positions and I don’t think they get to hear often enough the two words “thank you.” I was always giving them cards or bringing them back things when I went on vacation. They are the heart of the industry. And if we don’t start taking care of them, with praise and with bigger pay checks, those of us baby boomers are going to see a huge crisis in 20 years.

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  • http://eldercarenotebook.blogspot.com/ Gertrude

    I invite you to have a look at my website, the Elder Care Notebook. I am a CNA, and I’ve started posting some of my thoughts and tips. Hopefully it will help you get an idea of some standards you can expect from CNA’s, and give clients some idea of of what quality care includes.

    You are right about the pay and training, however there are often opportunities for dedicated CNA’s to keep up to date on their own. For example, Alzheimer’s groups have low-cost but extensive educational seminars that can actually be ahead of most packaged training, and include things like progress reports on the disease by world class physicians.

    Self training takes some initiative, but the opportunities are there. Local hospitals are also good sources. I say this understanding that the author is a trainer. Formal on-site training is important of course, but it’s just one factor.

    CNA pay is certainly a problem, but if you look at the total dollars spent by the clients, or those paying for the client including insurance and taxpayers, it shouldn’t be. There are some pretty hefty slices taken of along the way to the actual care provider. This results in not only poor pay, but just as important from the clients point of view, inadequate coverage, making good work difficult if not impossible.

    The reason any good CNA is doing this is not the money, certainly not for the respect, but for the love of the work and their genuine care for their clients.