Comments to Rule Set 2021-81 LR
The Health Care Association of Michigan (HCAM), which represents 361 skilled nursing facilities across the
state, would like to offer support for and suggested improvements to rule set 2021-81 LR. It is important that
the rule set is viewed in context of the significant workforce challenges experienced by long-term care, and the
need to ensure the thousands of unregistered aides working under the 1135 waivers have a pathway to the
CNA registry.
While sectors across the economy face similar challenges, the workforce shortage in the health care sector,
and nursing facilities specifically, is uniquely challenging. According to data from the U.S. Bureau of Labor
Statistics, the long-term care industry is facing the worst job loss among all health care providers. In Michigan,
an HCAM survey of membership indicates a 17% decrease in the workforce from pre-pandemic levels, with
currently more than 8,000 job openings.
To further avoid access issues for Michigan’s seniors needing around the clock skilled nursing care, it is
important that barriers are removed to help attract and retain individuals into the profession. HCAM’s
suggested improvements to the language are detailed below.
In order to help transition temporary aides onto the CNA registry, HCAM is working with a training
program and LARA to allow flexibility and enhance accessibility of training – such as remote/online
training and training conducted at a nursing facility. While the rules state the department shall conduct a
pre-permit survey within 60 days after an application is complete (400.332(4)), it is critical that the
department conduct this survey as expeditiously as possible, particularly during the federal Public
Health Emergency for COVID-19. Legislation has been introduced to outline an expedited timeline, and
it would be prudent to incorporate of similar language in these rules.
Part of the flexibility sought through remote training, and training conducted at a nursing facility, is to
have a nurse on staff approved as a trainer. The language in 400.335(1)(b) requires a training program
to have a permitted nurse aide trainer during classroom hours. HCAM requests that this language be
clarified to state that a permitted nurse trainer be available to the trainee.
Expand the restriction of 8 hours of self-study time under 400.335(d)(ii) to allow for the trainee to take
full advantage of the remote/online offering. Michigan rules require 34 classroom hours – all 34 hours
should be eligible through self-study time.
HCAM is very supportive of the language in 400.351(3). Offering options outside of flagging the CNA
for abuse and automatically losing registry ensures enforcement of the registry and safety of residents,
while also allowing CNAs to improve and continue as caregivers at a time when they are needed most.
To avoid unnecessary burdens for registry as a CNA in Michigan, HCAM requests clarifications stated above.
Rich Farran
V.P. Government Services
Health Care Association of Michigan
