Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.

Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. A violation of the provisions relating to those training requirements is a misdemeanor. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, including training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

This bill additionally would require the department, no later than December 31, 2025, to solicit applications from vendors to provide the written and oral competency examination of a nurse assistant certification examination in Spanish. The bill also would require the department, by July 1, 2029, to publish on its internet website, and to update at least twice annually, a list of information including, but not limited to, approved training programs, as specified, competency test pass rates for the previous 2 years, aggregated by the language in which the test was taken, and the number of nurse assistants trained in the previous 2 years.

Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.

Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. A violation of the provisions relating to those training requirements is a misdemeanor. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, including training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

This bill additionally would require the department, no later than December 31, 2025, to solicit applications from vendors to provide the written and oral competency examination of a nurse assistant certification examination in Spanish. The bill also would require the department, by July 1, 2029, to publish on its internet website, and to update at least twice annually, a list of information including, but not limited to, approved training programs, as specified, competency test pass rates for the previous 2 years, aggregated by the language in which the test was taken, and the number of nurse assistants trained in the previous 2 years.

Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.

Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. A violation of the provisions relating to those training requirements is a misdemeanor. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

This bill additionally would require the department to prepare and maintain on its internet website a list of approved training programs and to publish an update at least twice annually, to include the competency test pass rates, aggregated by the language in which the test was taken. The bill would require the department, no later than December 31, 2025, to make available the option to take solicit applications from vendors to provide the written and oral competency examination of a nurse assistant certification examination in Spanish. The bill would authorize the department to use a vendor contracted to provide testing services under a specified federal regulation to fulfill the requirement to provide the Spanish testing option. also would require the department, by July 1, 2029, to publish on its internet website, and to update at least twice annually, a list of information including, but not limited to, approved training programs, as specified, competency test pass rates for the previous 2 years, aggregated by the language in which the test was taken, and the number of nurse assistants trained in the previous 2 years.

Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.

Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. A violation of the provisions relating to those training requirements is a misdemeanor. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

This bill additionally would require the department to publish an update prepare and maintain on its internet website a list of approved training programs and to publish an update at least twice annually, and to include the competency test pass rates, aggregated by the language in which the test was taken. The bill would require the department, no later than December 31, 2025, to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish. The bill would require the department to contract with an approved testing vendor that would be responsible for translating the examination into Spanish. authorize the department to use a vendor contracted to provide testing services under a specified federal regulation to fulfill the requirement to provide the Spanish testing option.

Existing law establishes the State Department of Public Health and sets forth its powers and duties to license and administer health facilities, as defined, including skilled nursing facilities and intermediate care facilities.

Existing law requires skilled nursing facilities and intermediate care facilities to adopt certified nurse assistant training programs approved by the department. A violation of the provisions relating to those training requirements is a misdemeanor. Existing law requires the department to prepare and maintain a list of approved training programs for nurse assistant certification, training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

This bill additionally would require the department to publish an update of approved training programs at least twice annually, and to include the competency test pass rates, aggregated by the language in which the test was taken. The bill would require the department, no later than December 31, 2025, to provide, or contract with an approved vendor to provide, make available the option to take the written and oral competency examination of a nurse assistant certification examination that includes the option to take the written and oral competency examination in Spanish. The bill would require the department to contract with an approved testing vendor that would be responsible for translating the examination into Spanish.

Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. Existing law requires the department to develop a coordinated state strategy for addressing the health-related needs of women, including implementation of goals and objectives for womens health.

This bill would make a technical, nonsubstantive change to that provision.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2131

Author:(Valencia)

As Amended Ver:August 15, 2024

Majority vote

SUMMARY

Requires the Department of Public Health (DPH) to prepare, maintain, and publish at least twice a year, an updated list on its internet website of approved training programs for nurse assistant certification, aggregated by the language in which the test was taken. Requires DPH, no later than December 31, 2025, to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish. Requires DPH to contract with an approved testing vendor to translate the examination into Spanish.

Senate Amendments

1. Authorize DPH to use a vendor contracted to provide testing services under a specified federal regulation to fulfill the requirement to provide the Spanish testing option; and,
2. Require DPH, by July 1, 2029, to publish on its internet website, and to update at least twice annually, a list of information including, but not limited to, approved training programs, as specified, competency test pass rates for the previous two years, aggregated by the language in which the test was taken, and the number of nurse assistants trained in the previous two years.

COMMENTS

Certified Nurse Assistants (CNAs). An applicant for certification as a CNA must be at least sixteen years of age, have successfully completed a training program approved by DPH, which includes an examination to test the applicant's knowledge and skills related to basic patient care services, and obtain a criminal record clearance. CNAs provide basic care to patients under the supervision of a registered nurse (RN) or a Licensed Practical Nurse (LPN). CNAs are sometimes referred to as nurse aides, patient care technicians, or nursing assistants. Some of their essential responsibilities include:

1. Turning or Repositioning Patients: CNAs help patients change positions to prevent bedsores and improve comfort;
2. Gathering Supplies for the RN or Medical Doctor: They assist in preparing materials needed for medical procedures;
3. Checking and Charting Vital Signs: CNAs monitor patients' blood pressure, heart rate, temperature, and other vital signs;
4. Answering Patient Calls/Bells: They respond to patient requests for assistance;
5. Bathing, Feeding, and Dressing Patients: CNAs help with daily hygiene tasks;
6. Measuring and Recording Patient Food/Liquid Intake: They track the amount of food and fluids consumed; and,
7. Assisting Patients with Elimination: They assist patients with toileting needs.

CNAs play an important role in maintaining patient well-being and act as a liaison between nurses and patients. They work in various healthcare settings, including hospitals, skilled nursing facilities (SNFs), long-term residential facilities, rehabilitation centers, and adult daycare centers.

Workforce shortages. According to July 2022 Journal of Nurse Regulation, "Nursing Workforce Challenges in the Post-pandemic World," examining the pre- and post-COVID-19 pandemic literature on nursing turnover found that since the pandemic's onset, there has been a significant increase in nurse turnover intention. A 16-study synthesis of nurse burnout literature during the pandemic found high levels of emotional exhaustion and depersonalization, as well as reduced feelings of personal accomplishment. The same study also identified risk factors for burnout, including decreased social support, working in hospitals with inadequate and insufficient material and human resources, and increased workload. According to the Premier Nursing Academy, RNs and LPNs who are short-staffed often delegate more tasks to CNAs, increasing CNAs mental and physical fatigue which can eventually lead to burnout. A 2018 study indicates that approximately one-third of nurses' experience some level of burnout, and burnout rates may be as high as 50% for CNAs. Burnout can lead to poor job performance and, for many, leaving the profession.

Need for cultural competency in the workforce. According to the Latino Policy & Politics Institute Latino Data Hub, individuals who are limited English proficient make up 28.1% (4,055,000) of the Latino population in California. Studies show that rates of misdiagnosis and complications arise when the patients and healthcare professionals do not speak the same language. An April 2023 study, "Barriers in Healthcare for Latinx Patients with Limited English Proficiency," found that Latinos who report limited English proficiency experience discrimination, feel distrust in the healthcare setting, and face poorer health outcome than non-Latino whites. Low healthcare satisfaction and medical mistrust have been well demonstrated in the Latino community. These challenges lead to later hospital presentation, low healthcare utilization, and poor outcomes.

Massachusetts approved legislation allowing CNAs to take their written tests in Spanish and Chinese beginning in 2024.

According to the Author

This bill ensures better accessibility to individuals looking to be a CNA by requiring the written and oral portion of the CNA competency exam to be offered in Spanish. The author concludes that making the exam available in one of the most commonly spoken languages other than English in California, will create more linguistically competent care for California patients with limited English proficiency, help build the workforce pipeline to one that is more reflective of our population and address the critical workforce shortages.

Arguments in Support

SEIU California supports this bill and states that while many CNA training programs provide translated versions of the approved DPH materials during training, the CNA exam is only offered in English. This language barrier dissuades experienced care providers with LEP from pursuing CNA certification. By expanding the CNA exam test language to Spanish, the potential worker pool would expand dramatically, allowing the state to measure the impact of providing testing in preferred languages.
The California Association of Health Facilities (CAHF) states that SNFs continue to face a historic workforce crisis brought on by the pandemic. According to the Bureau of Labor Statistics, the sector has lost nearly 229,000 caregivers (or more than 14% of its workforce) since February 2020, the worst job loss among all health care sectors. CAHF concludes that this bill will expand access to the CAN training, education and certification to individuals desiring to enter the profession.

Arguments in Opposition

The Department of Finance is opposed to this bill because it creates additional ongoing costs on the Licensing and Certification Fund. Additionally, Finance notes that to the extent an aggregate of bills chapter that impact the Licensing and Certification Fund, it may expedite the need for a fee increase to support expenditures.

FISCAL COMMENTS

According to the Senate Appropriations Committee, unknown ongoing costs for DPH for administration and unknown one-time costs for information technology (Licensing and Certification Fund).

VOTES:

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin, Villapudua

ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta

ASSEMBLY FLOOR: 74-0-6

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis

UPDATED

VERSION: August 15, 2024

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0004178

 THIRD READING  

Bill No: AB 2131

Author: Valencia (D), et al.

Amended: 8/15/24 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 6/5/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/15/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

ASSEMBLY FLOOR: 74-0, 5/21/24 - See last page for vote

SUBJECT: Certified nurse assistant training programs

SOURCE: Service Employees International Union California State Council

DIGEST:

This bill requires the California Department of Public Health (CDPH), twice a year, to update and publish on its website a list of approved training programs for certified nurse assistants (CNAs). This bill requires CDPH to solicit applications from vendors to provide the CNA exam in Spanish.

ANALYSIS:

Existing law:

1. Defines a “CNA” as any person who holds them self out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person, and requires CNA services to be performed under the supervision of a registered nurse or licensed vocational nurse. [Health and Safety Code (HSC) §1337]
2. Requires CDPH to prepare and maintain a list of approved training programs for CNAs. Requires the list to include training programs conducted by skilled nursing facilities (SNFs) or intermediate care facilities (ICFs), as well as local agencies and education programs. Requires the list to include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. [HSC §1337.3(a)]
3. Requires CDPH, in consultation with the State Department of Education and other appropriate organizations, to develop criteria for approving training programs, that includes program content for orientation, training, in-service and the examination for testing knowledge and skills related to basic patient care services and develop a plan that identifies and encourages career ladder opportunities for CNAs. [HSC §1337.3(d)]

This bill:

1. Requires CDPH, by December 31, 2025, to solicit applications from vendors to provide the written and oral competency portion of a CNA exam in Spanish.
2. Requires CDPH, by July 1, 2029, to publish on its website, and update at least twice annually:
   1. All approved training programs, including SNFs, ICFs, and local agencies and education programs;
   2. Whether each training center is currently training CNAs;
   3. The competency test pass rates for the previous two years, aggregated by language in which the test was taken; and,
   4. The number of CNAs trained in the previous two years.

Comments

1. Author’s statement. According to the author, this bill ensures better accessibility to individuals looking to be a CNA by requiring the written and oral portion of the CNA competency exam to be offered in Spanish. Making the exam available in one of the most commonly spoken languages other than English in California will create more linguistically competent care for California patients with limited English proficiency (LEP), help build the workforce pipeline to one that is more reflective of our population, and address the critical workforce shortages. This bill also requires CDPH to update, twice yearly, a list of approved training programs on their website, to allow potential students and stakeholders to make informed decisions about training programs. Additionally, the bill requires CDPH to include the test pass rates, aggregated by language in order to understand how individuals are passing/failing their competency exam.
2. CNAs. According to the U.S. Bureau of Labor Statistics, there were 105,750 CNAs employed in California in 2023. To become a CNA, individuals must be at least 16 years old, pass a physical/health screening and criminal background check, complete an approved training program consisting of at least 60 classroom hours and 100 hours of clinical practice, and pass a state CNA certification examination. A person may only use the title, and hold themselves out as a CNA if they are working in a health facility licensed by CDPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. According to a January 2023 Issue Brief by the California Health Care Foundation (CHCF), CNAs are paid approximately $18 dollars an hour for mainly providing custodial care (nonmedical, personal care support for activities of daily living - eating, dressing, bathing, and toileting; or instrumental activities of daily living - housekeeping, chores, and meal preparation). CNAs also provide limited skilled care for patients (managing medical conditions, monitoring health status, or assisting with health-related tasks such as changing bandages, taking blood pressure and assisting with range-of-motion exercises). According to the CHCF Issue Brief, many of California’s direct care workers (including CNAs) come from historically marginalized backgrounds: 80% are women; almost half (47%) are immigrants; and, over three-quarters are people of color (38% Latino; 24% Asian, Native Hawaiian, and Pacific Islander; 12% Black; 3% other).
3. Aging population and demand for CNAs. According to the CHCF Issue Brief, by 2030, one in four Californians will be age 60 or older. Over the next decade, demand for direct care workers will outpace supply in California, with an estimated shortage of 600,000 to 3.2 million direct care workers by 2030. Growing demand is driven by an aging and increasingly diverse population, fewer working-aged adults and family caregivers to support this aging population, a growing desire to remain in home and community-based settings, and an increased need for complex care provided in facility-based long-term care settings. Several factors constrain the supply of direct care workers. Direct care work is physically and emotionally demanding, yet wages for direct care workers remain low, and many direct care workers live in poverty. This contributes to high rates of burnout, turnover, and fewer people willing to perform these jobs. Direct care workers were on the front line during the COVID-19 pandemic, but they were often rendered invisible despite their essential role, receiving little support, supplies, or resources from their employers.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, unknown ongoing costs for the CDPH for administration and unknown one-time costs for information technology (Licensing and Certification Fund).

SUPPORT: (Verified 8/14/24)

Service Employees International Union California State Council (source)

California Association of Health Facilities

California Immigrant Policy Center

LeadingAge California

OPPOSITION: (Verified 8/14/24)

None received

ARGUMENTS IN SUPPORT: Service Employees International Union California State Council (SEIU California) is the sponsor of this bill and states that to build the CNA workforce and to ensure our growing and diverse population of older adults receive linguistically competent care, California must recognize its valuable LEP caregivers. Latino individuals aged 65+ are projected to more than double from 1.4 million in 2020 to 2.9 million in 2040. Of those aged 65+ in California, an estimated 17% speak Spanish, and 64% of them say that they speak English less well. While many CNA training programs provide translated versions of the approved CDPH materials during training, the CNA exam is only offered in English. This language barrier dissuades experienced care providers with LEP from pursuing CNA certification. By expanding the CNA exam test language to Spanish, the potential worker pool would expand dramatically, allowing the state to measure the impact of providing testing in preferred languages. Additionally, SEIU California states that current law requires CDPH to prepare and maintain a list of CNA training programs that includes information on whether the program is currently offering training, how many individuals a program has trained, and the average pass rate of the program. This detailed information on the training programs is absent from the CDPH website and it instead only displays a list of 400+ training programs with business name, physical address, and phone number. Those interested in joining the workforce are given an overwhelming number of options, with little context on which program is right for them. SEIU California concludes that publishing the list online with success metrics and training availability will increase accessibility for those looking to become a CNA and allow individuals to make better-informed decisions.

The California Association of Health Facilities (CAHF) supports this bill and states that SNFs continue to face a historic workforce crisis brought on by the pandemic. According to the U.S. Bureau of Labor Statistics, the sector has lost nearly 229,000 caregivers (or more than 14% of its workforce) since February 2020, the worst job loss among all health care sectors. The lack of available staff has forced more than 60% of nursing homes nationwide to limit new patient admissions – impacting hospitals that are seeking to free up precious beds and preventing seniors from accessing the care they need. CAHF concludes that by providing more information about where to get CNA training and requiring the exam be offered in Spanish, this bill will expand access to the CNA training, education and certification to individuals desiring to enter the profession.

Support if amended. The California Association for Health Services at Home (CAHSAH) supports the efforts being made to improve California’s allied health workforce, especially given the growing need for more caregivers as our state’s senior population continues to increase exponentially each year. Home health agencies are experiencing more hospitals referring patients for home health services and California needs to be ready with a qualified workforce to meet the growing demands of individuals who wish to receive care in their homes. CAHSH appreciates the author’s efforts to add competency evaluations for CNAs and asks that the bill be amended to also include certified home health aides. Certified home health aide training programs are very limited throughout the state and many counties do not offer these certification programs in their colleges or in the community. California’s Title 22 regulations require home health agencies to utilize certified home health aides. Health and Safety Code Section 1736.1 currently provides an option for a certified home health aide to take a competency evaluation-training program approved by CDPH pursuant to applicable federal and state regulations. However, CDPH has not established that competency examination for certified home health aides.

ASSEMBLY FLOOR: 74-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis

Prepared by: Melanie Moreno / HEALTH / (916) 651-4111

8/18/24 18:22:21

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2131 (Valencia) - Certified nurse assistant training programs

Bill Summary:

AB 2131 would require the California Department of Public Health (CDPH) to publish at least twice annually, an updated list on its internet website of approved training programs for nurse assistant certification, as specified; and require CDPH to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 15, 2024

Fiscal Impact:

Unknown ongoing costs for the CDPH for administration and unknown one-time costs for information technology (Licensing and Certification Fund).

Author Amendments:

Revise the provisions to instead require:

• The CDPH to solicit applications from vendors to provide the written and oral competency examination of a nurse assistant certification examination in Spanish.
• No later than July 1, 2029, the CDPH to publish on its internet website, and update at least twice annually, a list including all of the following:
  • All approved training programs, including skilled nursing facilities, intermediate care facilities, and local agencies and education programs.
  • Whether each training center is currently training nurse assistants.
  • The competency test pass rates for the previous two years, aggregated by the language in which the test was taken.
  • The number of nurse assistants trained in the previous two years.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2131 (Valencia) - Certified nurse assistant training programs

Bill Summary:

AB 2131 would require the California Department of Public Health (CDPH) to publish at least twice annually, an updated list on its internet website of approved training programs for nurse assistant certification, as specified; and require CDPH to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish

Fiscal Impact:

The CDPH estimates the following costs (Licensing and Certification Fund):

• $1,490,980 in 2026-27, $2,555,965 in 2027-28, $2,477,606 in 2028-29 and $1,694,781 ongoing thereafter to develop the data publication.
• $1.6 million, over 17 months, related to information technology to begin the process for Project Approval Lifecycle (PAL) review and approval. The process includes an initial analysis to develop comprehensive planning that ensures the appropriate IT solution is selected and managed. This cost would be further refined and updated after all the required PAL planning stages are completed.

Background:

Current law defines a certified nurse assistant (CNA) as any person who holds them self out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Current law prohibits CNA services from including any services which may only be performed by a licensed person, and requires CNA services to be performed under the supervision of a registered nurse or licensed vocational nurse.

Current law requires CDPH to prepare and maintain a list of approved training programs for CNA certification. The list must include training programs conducted by skilled nursing facilities (SNFs) or intermediate care facilities (ICFs), as well as local agencies and education programs. The list must include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained.

Current law requires CDPH, in consultation with the State Department of Education and other appropriate organizations, to develop criteria for approving training programs, that includes program content for orientation, training, in-service and the examination for testing knowledge and skills related to basic patient care services.

Proposed Law:

Specific provisions of the bill would:

• Require CDPH to publish at least twice annually, an updated list on its internet website of approved training programs for nurse assistant certification.
• Require that competency test pass rates must be aggregated by the language in which the test was taken.
• Require CDPH to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish; and require CDPH to contract with an approved testing vendor to be responsible for translating the examination into Spanish.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2131

SUBJECT: Certified nurse assistant training programs

SUMMARY:

Requires the California Department of Public Health (CDPH), twice a year, to update and publish on its website a list of approved training programs for certified nurse assistants (CNAs). Requires CDPH to make the CNA exam available in Spanish.

Existing law:

1. Defines a “CNA” as any person who holds them self out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person, and requires CNA services to be performed under the supervision of a registered nurse or licensed vocational nurse. [HSC §1337]
2. Requires CDPH to prepare and maintain a list of approved training programs for CNAs. Requires the list to include training programs conducted by skilled nursing facilities (SNFs) or intermediate care facilities (ICFs), as well as local agencies and education programs. Requires the list to include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. [HSC §1337.3(a)]
3. Requires CDPH, in consultation with the State Department of Education and other appropriate organizations, to develop criteria for approving training programs, that includes program content for orientation, training, in-service and the examination for testing knowledge and skills related to basic patient care services and develop a plan that identifies and encourages career ladder opportunities for CNAs. [HSC §1337.3(d)]

This bill:

1. Requires CDPH, at least twice annually, to update and post on its website the approved CNA training program list. Requires the list to have competency test pass rates aggregated by the language in which the test was taken.
2. Requires CDPH, by December 31, 2025, to make available the option to take the written and oral competency portion of a CNA exam in Spanish. Requires CDPH to contract with an approved testing vendor for translating the examination into Spanish.

FISCAL EFFECT:

1. According to the Assembly Appropriations Committee, costs of an unknown amount, potentially in the low hundreds of thousands of dollars annually, for CDPH to review and approve additional training programs, add information to its website, and contract with a testing vendor to provide examinations in Spanish (Licensing and Certification Fund).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill ensures better accessibility to individuals looking to be a CNA by requiring the written and oral portion of the CNA competency exam to be offered in Spanish. Making the exam available in one of the most commonly spoken languages other than English in California will create more linguistically competent care for California patients with limited English proficiency (LEP), help build the workforce pipeline to one that is more reflective of our population, and address the critical workforce shortages. This bill also requires CDPH to update, twice yearly, a list of approved training programs on their website, to allow potential students and stakeholders to make informed decisions about training programs. Additionally, the bill requires CDPH to include the test pass rates, aggregated by language in order to understand how individuals are passing/failing their competency exam.
2. CNAs. According to the U.S. Bureau of Labor Statistics, there were 105,750 CNAs employed in California in 2023. To become a CNA, individuals must be at least 16 years old, pass a physical/health screening and criminal background check, complete an approved training program consisting of at least 60 classroom hours and 100 hours of clinical practice, and pass a state CNA certification examination. A person may only use the title, and hold themselves out as a CNA if they are working in a health facility licensed by CDPH. The majority of CNAs work in SNFs and perform a variety of basic duties for the patient’s comfort and recovery. A somewhat smaller number of CNAs work in other settings, such as hospitals, assisted living facilities, and private homes. According to a January 2023 Issue Brief by the California Health Care Foundation (CHCF), CNAs are paid approximately $18 dollars an hour for mainly providing custodial care (nonmedical, personal care support for activities of daily living - eating, dressing, bathing, and toileting; or instrumental activities of daily living - housekeeping, chores, and meal preparation). CNAs also provide limited skilled care for patients (managing medical conditions, monitoring health status, or assisting with health-related tasks such as changing bandages, taking blood pressure and assisting with range-of-motion exercises). According to the CHCF Issue Brief, many of California’s direct care workers (including CNAs) come from historically marginalized backgrounds: 80% are women; almost half (47%) are immigrants; and, over three-quarters are people of color (38% Latino; 24% Asian, Native Hawaiian, and Pacific Islander; 12% Black; 3% other).
3. Aging population and demand for CNAs. According to the CHCF Issue Brief, by 2030, one in four Californians will be age 60 or older. Over the next decade, demand for direct care workers will outpace supply in California, with an estimated shortage of 600,000 to 3.2 million direct care workers by 2030. Growing demand is driven by an aging and increasingly diverse population, fewer working-aged adults and family caregivers to support this aging population, a growing desire to remain in home and community-based settings, and an increased need for complex care provided in facility-based long-term care settings. Several factors constrain the supply of direct care workers. Direct care work is physically and emotionally demanding, yet wages for direct care workers remain low, and many direct care workers live in poverty. This contributes to high rates of burnout, turnover, and fewer people willing to perform these jobs. Direct care workers were on the front line during the COVID-19 pandemic, but they were often rendered invisible despite their essential role, receiving little support, supplies, or resources from their employers.
4. Prior legislation. AB 2850 (Rubio, Chapter 769, Statutes of 2018) permits SNFs, ICFs, or educational institutions to conduct the 60 classroom hours of training for CNAs in an online or distance learning course format, as approved by CDPH.

SB 449 (Monning, Chapter 282, Statutes of 2017) requires at least two of the 60 hours of classroom training that is required as part of the training program for CNAs to address the special needs of persons with Alzheimer’s disease and related dementias.

1. Support. Service Employees International Union California State Council (SEIU California) is the sponsor of this bill and states that to build the CNA workforce and to ensure our growing and diverse population of older adults receive linguistically competent care, California must recognize its valuable LEP caregivers. Latino individuals aged 65+ are projected to more than double from 1.4 million in 2020 to 2.9 million in 2040. Of those aged 65+ in California, an estimated 17% speak Spanish, and 64% of them say that they speak English less well. While many CNA training programs provide translated versions of the approved CDPH materials during training, the CNA exam is only offered in English. This language barrier dissuades experienced care providers with LEP from pursuing CNA certification. By expanding the CNA exam test language to Spanish, the potential worker pool would expand dramatically, allowing the state to measure the impact of providing testing in preferred languages. Additionally, SEIU California states that current law requires CDPH to prepare and maintain a list of CNA training programs that includes information on whether the program is currently offering training, how many individuals a program has trained, and the average pass rate of the program. This detailed information on the training programs is absent from the CDPH website and it instead only displays a list of 400+ training programs with business name, physical address, and phone number. Those interested in joining the workforce are given an overwhelming number of options, with little context on which program is right for them. SEIU California concludes that publishing the list online with success metrics and training availability will increase accessibility for those looking to become a CNA and allow individuals to make better-informed decisions.

The California Association of Health Facilities (CAHF) supports this bill and states that SNFs continue to face a historic workforce crisis brought on by the pandemic. According to the U.S. Bureau of Labor Statistics, the sector has lost nearly 229,000 caregivers (or more than 14% of its workforce) since February 2020, the worst job loss among all health care sectors. The lack of available staff has forced more than 60% of nursing homes nationwide to limit new patient admissions – impacting hospitals that are seeking to free up precious beds and preventing seniors from accessing the care they need. CAHF concludes that by providing more information about where to get CNA training and requiring the exam be offered in Spanish, this bill will expand access to the CNA training, education and certification to individuals desiring to enter the profession.

1. Support if amended. The California Association for Health Services at Home (CAHSAH) supports the efforts being made to improve California’s allied health workforce, especially given the growing need for more caregivers as our state’s senior population continues to increase exponentially each year. Home health agencies are experiencing more hospitals referring patients for home health services and California needs to be ready with a qualified workforce to meet the growing demands of individuals who wish to receive care in their homes. CAHSH appreciates the author’s efforts to add competency evaluations for CNAs and asks that the bill be amended to also include certified home health aides. Certified home health aide training programs are very limited throughout the state and many counties do not offer these certification programs in their colleges or in the community. California’s Title 22 regulations require home health agencies to utilize certified home health aides. Health and Safety Code Section 1736.1 currently provides an option for a certified home health aide to take a competency evaluation-training program approved by CDPH pursuant to applicable federal and state regulations. However, CDPH has not established that competency examination for certified home health aides.
2. Technical amendments. The author has agreed to take the following technical, clarifying amendments:

1337.3. (a) (1)  The department shall prepare and maintain a list on its internet website prepare, maintain, and publish at least twice annually, an updated list on its internet website  of approved training programs for nurse assistant certification. The list shall be updated at least twice annually and include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs.

1337.3(a)(2) (2) No later than December 31, 2025, the department shall make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish. The department may use the vendor that is contracted to provide testing services pursuant to 42 CFR § 483.154 (c) to fulfill this requirement. shall contract with an approved testing vendor that shall be responsible for translating the examination into Spanish.

SUPPORT AND OPPOSITION:

Support: Service Employees International Union California State Council (sponsor)

California Association of Health Facilities

LeadingAge California

Oppose: None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2131

Author:(Valencia)

As Amended Ver:May 16, 2024

Majority vote

SUMMARY

Requires the Department of Public Health (DPH) to prepare, maintain, and publish at least twice a year, an updated list on its internet website of approved training programs for nurse assistant certification, aggregated by the language in which the test was taken. Requires DPH, no later than December 31, 2025, to make available the option to take the written and oral competency examination of a nurse assistant certification examination in Spanish. Requires DPH to contract with an approved testing vendor to translate the examination into Spanish.

Major Provisions

COMMENTS

Certified Nurse Assistants (CNAs). An applicant for certification as a CNA must be at least sixteen years of age, have successfully completed a training program approved by DPH, which includes an examination to test the applicant's knowledge and skills related to basic patient care services, and obtain a criminal record clearance. CNAs provide basic care to patients under the supervision of a registered nurse (RN) or a Licensed Practical Nurse (LPN). CNAs are sometimes referred to as nurse aides, patient care technicians, or nursing assistants. Some of their essential responsibilities include:

1. Turning or Repositioning Patients: CNAs help patients change positions to prevent bedsores and improve comfort;
2. Gathering Supplies for the RN or Medical Doctor: They assist in preparing materials needed for medical procedures;
3. Checking and Charting Vital Signs: CNAs monitor patients' blood pressure, heart rate, temperature, and other vital signs;
4. Answering Patient Calls/Bells: They respond to patient requests for assistance;
5. Bathing, Feeding, and Dressing Patients: CNAs help with daily hygiene tasks;
6. Measuring and Recording Patient Food/Liquid Intake: They track the amount of food and fluids consumed; and,
7. Assisting Patients with Elimination: They assist patients with toileting needs.

CNAs play an important role in maintaining patient well-being and act as a liaison between nurses and patients. They work in various healthcare settings, including hospitals, skilled nursing facilities (SNFs), long-term residential facilities, rehabilitation centers, and adult daycare centers.

Workforce shortages. According to July 2022 Journal of Nurse Regulation, "Nursing Workforce Challenges in the Post-pandemic World," examining the pre- and post-COVID-19 pandemic literature on nursing turnover found that since the pandemic's onset, there has been a significant increase in nurse turnover intention. A 16-study synthesis of nurse burnout literature during the pandemic found high levels of emotional exhaustion and depersonalization, as well as reduced feelings of personal accomplishment. The same study also identified risk factors for burnout, including decreased social support, working in hospitals with inadequate and insufficient material and human resources, and increased workload. According to the Premier Nursing Academy, RNs and LPNs who are short-staffed often delegate more tasks to CNAs, increasing CNAs mental and physical fatigue which can eventually lead to burnout. A 2018 study indicates that approximately one-third of nurses' experience some level of burnout, and burnout rates may be as high as 50% for CNAs. Burnout can lead to poor job performance and, for many, leaving the profession.

Need for cultural competency in the workforce. According to the Latino Policy & Politics Institute Latino Data Hub, individuals who are limited English proficient make up 28.1% (4,055,000) of the Latino population in California. Studies show that rates of misdiagnosis and complications arise when the patients and healthcare professionals do not speak the same language. An April 2023 study, "Barriers in Healthcare for Latinx Patients with Limited English Proficiency," found that Latinos who report limited English proficiency experience discrimination, feel distrust in the healthcare setting, and face poorer health outcome than non-Latino whites. Low healthcare satisfaction and medical mistrust have been well demonstrated in the Latino community. These challenges lead to later hospital presentation, low healthcare utilization, and poor outcomes.

Massachusetts approved legislation allowing CNAs to take their written tests in Spanish and Chinese beginning in 2024.

According to the Author

This bill ensures better accessibility to individuals looking to be a CNA by requiring the written and oral portion of the CNA competency exam to be offered in Spanish. The author concludes that making the exam available in one of the most commonly spoken languages other than English in California, will create more linguistically competent care for California patients with limited English proficiency, help build the workforce pipeline to one that is more reflective of our population and address the critical workforce shortages.

Arguments in Support

SEIU California State Council (SEIU California) is the sponsor of this bill and states that to build the CNA workforce and to ensure our growing and diverse population of older adults receives linguistically competent care, California must recognize its valuable caregivers with limited English proficiency (LEP). Latino individuals aged 65+ are projected to more than double from 1.4 million in 2020 to 2.9 million in 2040. Of those aged 65+ in California, an estimated 17% speak Spanish, and 64% of them say that they speak English less well. While many CNA training programs provide translated versions of the approved DPH materials during training, the CNA exam is only offered in English. This language barrier dissuades experienced care providers with LEP from pursuing CNA certification. By expanding the CNA exam test language to Spanish, the potential worker pool would expand dramatically, allowing the state to measure the impact of providing testing in preferred languages. There is precedent in several other states that allow for the CNA exam to be offered in Spanish.

Current law requires DPH to prepare and maintain a list of CNA training programs that includes information on whether the program is currently offering training, how many individuals a program has trained, and the average pass rate of the program. This detailed information on the training programs is absent from the DPH website and it instead only displays a list of 400+ training programs with business name, physical address, and phone number. Those interested in joining the workforce are given an overwhelming number of options, with little context on which program is right for them. SEIU California concludes that publishing the list online with success metrics and training availability will increase accessibility for those looking to become a CNA and allow individuals to make better-informed decisions.

California Association of Health Facilities (CAHF) supports this bill and states that SNFs continue to face a historic workforce crisis brought on by the pandemic. According to the Bureau of Labor Statistics, the sector has lost nearly 229,000 caregivers (or more than 14% of its workforce) since February 2020, the worst job loss among all health care sectors. The lack of available staff has forced more than 60% of nursing homes nationwide to limit new patient admissions – impacting hospitals that are seeking to free up precious beds and preventing seniors from accessing the care they need. CAHF concludes that by providing more information about where to get CNA training and requiring the exam be offered in Spanish, this bill will expand access to the CNA training, education and certification to individuals desiring to enter the profession.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, costs of an unknown amount, potentially in the low hundreds of thousands of dollars annually, for DPH to review and approve additional training programs, add information to its website, and contract with a testing vendor to provide examinations in Spanish (Licensing and Certification Fund).

VOTES

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin, Villapudua

ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta

UPDATED

VERSION: May 16, 2024

CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003321

Date of Hearing: May 8, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2131

Author:(Valencia) – As Amended Ver:March 18, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to provide a nurse assistant certification examination that may be taken in Spanish. The bill also increases, from annually to twice annually, the frequency at which CDPH must update and publish on its website a list of approved nurse assistant certification training programs, and requires the list to be aggregated by the test language of the nurse assistants who completed a program.

FISCAL EFFECT:

CDPH estimates significant costs, potentially in the millions of dollars over five years, to provide a nurse assistant certification examination that may be taken in Spanish and to add and maintain information on its website (Licensing and Certification Fund). CDPH indicates it does not currently provide nurse assistant examinations, nor does it contract with another organization to do so. However, the author’s intent is not for CDPH to create the examination. A different interpretation of the bill would likely result in a significantly lower cost estimate.

COMMENTS:

1. Purpose. This bill is sponsored by SEIU California. According to the author:

AB 2131 ensures better accessibility to individuals looking to be a Certified Nursing Assistant by requiring the written and oral portion of the Certified Nursing Assistant competency exam to be offered in Spanish. Making the exam available in one of the most commonly spoken languages other than English in California, will create more linguistically competent care for California patients with limited English proficiency, help build the workforce pipeline to one that is more reflective of our population and address the critical workforce shortages.

1. Background. Certified Nursing Assistants (CNAs) play an important role in maintaining patient well-being and act as a liaison between nurses and patients. They work in various healthcare settings, including hospitals, skilled nursing facilities, long-term residential facilities, rehabilitation centers, and adult daycare centers. CNAs provide basic care to patients under the supervision of a registered nurse or a Licensed Practical Nurse. CNAs are sometimes referred to as nurse aides, patient care technicians, or nursing assistants. Some of their essential responsibilities include:
   
   1. Turning or repositioning patients to prevent bedsores and improve comfort.
      
   2. Gathering supplies needed for medical procedures.
      
   3. Checking and charting vital signs.
      
   4. Responding to patient requests for assistance.
      
   5. Bathing, feeding, and dressing patients.
      
   6. Measuring and recording patient food and fluid intake.
      
   7. Assisting patients with toileting needs.
      

An applicant for certification as a CNA must be at least 16 years old, obtain a criminal record clearance, and successfully complete a CDPH-approved training program, which includes an examination to test the applicant’s knowledge and skills related to basic patient care services.

1. Ambiguous Language. The author may wish to amend this bill to clarify CDPH’s responsibility, as noted in the fiscal estimate.
   
2. Prior Legislation. AB 2850 (Rubio), Chapter 769, Statutes of 2018, permits skilled nursing facilities, intermediate care facilities, or educational institutions to conduct the 60 classroom hours of training for CNAs in an online or distance learning course format, as approved by CDPH.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 16, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2131

Author:(Valencia) – As Amended Ver:March 18, 2024

SUBJECT: Certified nurse assistant training programs.

SUMMARY: Requires the Department of Public Health (DPH) to prepare, maintain, and publish at least twice a year, an updated list on its internet website of approved training programs for nurse assistant certification, aggregated by the language in which the test was taken. Requires DPH, no later than December 31, 2025, to provide, or contract with an approved vendor to provide a nurse assistant certification examination that includes the option to take the written and oral competency examination in Spanish.

EXISTING LAW:

1. Requires certain health facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs), to be licensed by DPH. [Health and Safety Code (HSC) §1250, et. seq.]
2. Defines a “certified nurse assistant (CNA)” as any person who holds themselves out as a CNA and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed training requirements in existing law. Prohibits CNA services from including any services which may only be performed by a licensed person and requires those services to be performed under the supervision of a registered nurse (RN) or a licensed vocational nurse. [HSC §1337]
3. Requires a SNF or ICF to adopt an approved training program that meets standards established by DPH. Requires the training program to consist of at least an orientation program to be given to newly employed nurse assistants prior to providing direct patient care in SNFs or ICFs and a precertification training program consisting of at least 60 hours of training, as specified. [HSC §1337.1]
4. Places the following requirements on the 60 hours of training:
5. At least two hours of the 60 hours of training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness;
6. At least two hours to address the special needs of persons with Alzheimer’s disease and related dementias;
7. A minimum of six hours of instruction on preventing, recognizing, and reporting instances of resident abuse utilizing specified courses; and,
8. A minimum of one hour of instruction on preventing, recognizing, and reporting residents’ rights violations. [Ibid.]
9. Requires the precertification training program, in addition to the 60 hours of training, to consist of at least 100 hours of supervised and on-the-job training clinical practice. Permits the 100 hours to consist of normal employment as a nurse assistant under the supervision of either the director of nurse training or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training. Requires at least four hours of the 100 hours of supervised clinical training to address the special needs of persons with developmental and mental disorders, including intellectual disability, cerebral palsy, epilepsy, Alzheimer’s disease and related dementias, and Parkinson’s disease. [Ibid.]
   
10. Authorizes DPH to approve an online or distance learning nurse assistant training program that complies with the following requirements:
    1. Provide online instruction in which the trainees and the approved instructor are online at the same or similar times and which allows them to use real-time collaborative software that combines audio, video, file sharing, or any other forms of approved interaction and communication;
    2. Require the use of a personal identification number or personal identification information that confirms the identity of the trainees and instructors, including, but not limited to, having trainees sign an affidavit attesting under penalty of perjury to their identity while completing the program;
    3. Provide safeguards to protect personal information;
    4. Include policies and procedures to ensure that instructors are accessible to trainees outside of the normal instruction times;
    5. Include policies and procedures for equipment failures, student absences, and completing assignments past original deadlines;
    6. Provide a clear explanation on its Internet website of all technology requirements to participate and complete the program; and,
    7. Provide DPH with statistics about the performance of trainees in the program, including, but not limited to, exam pass rate and the rate at which trainees repeat each module of the program, and any other information requested by DPH regarding trainee participation in and completion of the program. [HSC §1337.16]
       

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill ensures better accessibility to individuals looking to be a CNA by requiring the written and oral portion of the CNA competency exam to be offered in Spanish. The author concludes that making the exam available in one of the most commonly spoken languages other than English in California, will create more linguistically competent care for California patients with limited English proficiency, help build the workforce pipeline to one that is more reflective of our population and address the critical workforce shortages.
2. BACKGROUND.
   1. CNAs. An applicant for certification as a CNA must be at least sixteen years of age, have successfully completed a training program approved by DPH, which includes an examination to test the applicant’s knowledge and skills related to basic patient care services, and obtain a criminal record clearance. CNAs provide basic care to patients under the supervision of a RN or a Licensed Practical Nurse (LPN). CNAs are sometimes referred to as nurse aides, patient care technicians, or nursing assistants. Some of their essential responsibilities include:
      1. Turning or Repositioning Patients: CNAs help patients change positions to prevent bedsores and improve comfort;
      2. Gathering Supplies for the RN or Medical Doctor: They assist in preparing materials needed for medical procedures;
      3. Checking and Charting Vital Signs: CNAs monitor patients’ blood pressure, heart rate, temperature, and other vital signs;
      4. Answering Patient Calls/Bells: They respond to patient requests for assistance;
      5. Bathing, Feeding, and Dressing Patients: CNAs help with daily hygiene tasks;
      6. Measuring and Recording Patient Food/Liquid Intake: They track the amount of food and fluids consumed; and,
      7. Assisting Patients with Elimination: They assist patients with toileting needs.
         

CNAs play an important role in maintaining patient well-being and act as a liaison between nurses and patients. They work in various healthcare settings, including hospitals, SNFs, long-term residential facilities, rehabilitation centers, and adult daycare centers.

• 1. Workforce shortages. According to July 2022 Journal of Nurse Regulation, “Nursing Workforce Challenges in the Post-pandemic World,” examining the pre- and post-COVID-19 pandemic literature on nursing turnover found that since the pandemic’s onset, there has been a significant increase in nurse turnover intention. A 16-study synthesis of nurse burnout literature during the pandemic found high levels of emotional exhaustion and depersonalization, as well as reduced feelings of personal accomplishment. The same study also identified risk factors for burnout, including decreased social support, working in hospitals with inadequate and insufficient material and human resources, and increased workload. According to the Premier Nursing Academy, RNs and LPNs who are short-staffed often delegate more tasks to CNAs, increasing CNAs mental and physical fatigue which can eventually lead to burnout. A 2018 study indicates that approximately one-third of nurses’ experience some level of burnout, and burnout rates may be as high as 50% for CNAs. Burnout can lead to poor job performance and, for many, leaving the profession.
     
  2. Need for cultural competency in the workforce. According to the Latino Policy & Politics Institute Latino Data Hub, individuals who are limited English proficient make up 28.1% (4,055,000) of the Latino population in California. Studies show that rates of misdiagnosis and complications arise when the patients and healthcare professionals do not speak the same language. An April 2023 study, “Barriers in Healthcare for Latinx Patients with Limited English Proficiency,” found that Latinos who report limited English proficiency experience discrimination, feel distrust in the healthcare setting, and face poorer health outcome than non-Latino whites. Low healthcare satisfaction and medical mistrust have been well demonstrated in the Latino community. These challenges lead to later hospital presentation, low healthcare utilization, and poor outcomes.
     
     Massachusetts approved legislation allowing CNAs to take their written tests in Spanish and Chinese beginning in 2024.
     

1. SUPPORT. SEIU California State Council (SEIU California) is the sponsor of this bill and states that to build the CNA workforce and to ensure our growing and diverse population of older adults receives linguistically competent care, California must recognize its valuable caregivers with limited English proficiency (LEP). Latino individuals aged 65+ are projected to more than double from 1.4 million in 2020 to 2.9 million in 2040. Of those aged 65+ in California, an estimated 17% speak Spanish, and 64% of them say that they speak English less well. While many CNA training programs provide translated versions of the approved DPH materials during training, the CNA exam is only offered in English. This language barrier dissuades experienced care providers with LEP from pursuing CNA certification. By expanding the CNA exam test language to Spanish, the potential worker pool would expand dramatically, allowing the state to measure the impact of providing testing in preferred languages. There is precedent in several other states that allow for the CNA exam to be offered in Spanish.

Current law requires DPH to prepare and maintain a list of CNA training programs that includes information on whether the program is currently offering training, how many individuals a program has trained, and the average pass rate of the program. This detailed information on the training programs is absent from the DPH website and it instead only displays a list of 400+ training programs with business name, physical address, and phone number. Those interested in joining the workforce are given an overwhelming number of options, with little context on which program is right for them. SEIU California concludes that publishing the list online with success metrics and training availability will increase accessibility for those looking to become a CNA and allow individuals to make better-informed decisions.

California Association of Health Facilities (CAHF) supports this bill and states that SNFs continue to face a historic workforce crisis brought on by the pandemic. According to the Bureau of Labor Statistics, the sector has lost nearly 229,000 caregivers (or more than 14% of its workforce) since February 2020, the worst job loss among all health care sectors. The lack of available staff has forced more than 60% of nursing homes nationwide to limit new patient admissions – impacting hospitals that are seeking to free up precious beds and preventing seniors from accessing the care they need. CAHF concludes that by providing more information about where to get CNA training and requiring the exam be offered in Spanish, this bill will expand access to the CNA training, education and certification to individuals desiring to enter the profession.

1. PREVIOUS LEGISLATION.
   
   1. SB 525 (Durazo), Chapter 890, Statutes of 2023, enacts a phased in multi-tiered statewide minimum wage schedule for health care workers employed by covered healthcare facilities, as defined; requires, following the phased-in wage increases, the minimum wage for health care workers employed by covered healthcare facilities to be adjusted, as specified; provides a temporary waiver of wage increases under specified circumstances; and establishes a 10-year moratorium on wage ordinances, regulations, or administrative actions for covered health care facility employees, as specified.
   2. AB 2850 (Rubio), Chapter 769, Statutes of 2018, permits SNFs, ICFs, or educational institutions to conduct the 60 classroom hours of training for CNAs in an online or distance learning course format, as approved by DPH.
      

REGISTERED SUPPORT / OPPOSITION:

Support

SEIU California (sponsor)

California Association of Health Facilities
LeadingAge California

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097