Certified nursing assistants (CNAs) perform an important role in the long-term care system because they provide the majority of paid care to nursing facility residents. Unfortunately, annual CNA turnover often exceeds 100 percent nationally. Many factors account for this, including stressful working conditions, low pay, and limited benefits. The end result of high turnover is compromised continuity of care for residents, which often leads to poor quality and substandard care. In an effort to improve quality of care and staffing, the Virginia Department of Medical Assistance Services in 2009 implemented a pilot program, known as the Virginia Gold Quality Improvement Program, which provided funding to five nursing facilities to develop projects that improved working conditions for CNAs. This study presents the results of an evaluation performed on the program toward the end of its first year using 10 CNA and resident focus groups. Eight themes emerged from the focus groups, suggesting that both quality of care and working conditions improved in the pilot facilities after the program was implemented. However, these findings are preliminary and additional research is needed to more fully understand how the program influenced conditions in the pilot facilities.


Medicaid, Nursing Facility, Quality of Care, Quality Improvement, Certified Nursing Assistants, Supportive Work Environments, Civil Money Penalty Funds

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