HJAR Mar/Apr 2026

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2026 23 America’s Care System at a Crossroads America’s care system is at a crossroads. Certified nursing assistants (CNAs) and direct care workers remain the backbone of elder care, yet turnover is high and demands are rising. The solution is not more strain on one group, but the creation of a workforce ecosystem— where technology, new professional roles, volunteers, fami- lies, neighborhoods, and evidence-based models like CAPABLE (Community Aging in Place —Advancing Better Living for Elders) share the load. This article, the second in our Caring Together series, explores how such a system can sustain dignity, independence, and connection for older adults, while building a stronger future of care for all. Why the Workforce Matters The ombudsman knocked on the open door. Mr. Henry sat tapping his cane, eye- ing the clock. With a twinkle in his eye, he muttered, “If I wait much longer, I’ll need Noah to build me an ark.” Ms. Mary, a CNA, rushed in — breathless but smiling. “Oh, Mr. Henry, I’m so sorry. Twelve other folks suddenly needed bathrooms all at once.” “Unlucky number thirteen,” he chuckled. She laughed, helping him up. “You’re not unlucky — just very patient.” That brief exchange shows something essential: Even in moments of delay and strain, frontline caregivers can turn frustration into dignity through kindness, humor, and presence. Yet too often, as one seasoned nurse observed, residents and staff alike are caught in cycles of loneliness, boredom, and helplessness — the three plagues of nursing homes. Without meaningful engagement, days feel long, moods sour, and frustrations spill over. Conversely, when residents experience purpose through activities that matter — beyond bingo or passive entertainment — the ripple effect is profound. As she put it: “Happy staff make happy residents, but happy residents make happy staff.” The CNA Workforce Today In nursing homes, assisted living, ARCHs (adult residential care homes), hospitals, and private residences, CNAs may go by different titles. Sometimes they’re called per- sonal care aides (PCAs), home health aides (HHAs), or direct care workers (DCWs). But no matter what titles are in play, the workforce as a whole is in crisis. National data show CNA turnover is still the highest among nursing home roles — about 42% in 2025, down slightly from 44.16% in 2024 (American Health CareAssociation, 2025; LeadingAge, 2025). 1 According to PHI’s 2024 data, median annual earnings for direct care workers are about $25,015, with 36% living in or near poverty and 49% relying on public assistance. 2 These pressures — combined with physically demanding work, double shifts, and limited benefits — fuel instability across the workforce. And the need is only growing. By 2030, one in five Americans will be 65 or older. By 2060, the older adult population will nearly double to 95 million, with the 85+ group tripling in size. 3 At the same time, family caregivers already provide $600 bil- lion worth of unpaid care annually. 4 PART 2 CNAs at the Core — Building a Circle of Care for the Future of Aging ROSALYNN CARTER ON CAREGIVING “There are only four kinds of people in the world: those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” — Former First Lady Rosalynn Carter Caregiving touches us all — which is why strengthening the workforce of care is everyone’s responsibility. DIRECTOR OF NURSING’S PERSPECTIVE “CNAs are the backbone of the building.” — Nursing Home Director of Nursing (DON) This DON emphasized that CNAs should be elevated to a professional level that people aspire to achieve — not just a stepping stone to other nursing roles.