Monica Christiansen walks into Consultants for Children in Aurora, Colorado, on a Thursday afternoon with a wide smile.
"This is the highlight of my day," she says as she opens the front door to the business, an autism center that serves the greater Denver area.
Christiansen is on her way to pick up her daughter, 10-year-old Chloe: something she has done three days a week for several years, but it is still something that gives her excitement despite the amount of work it requires.
"I have to put [Chloe's] shoes on, prepare her lunch, everything. For most people, when their child is 10, they can do most of that themselves — they're pretty independent. But for Chloe, I have to do everything for her," said Christiansen.
Christiansen is Chloe's main caretaker, but for the last year that role of mother and caretaker has included the title certified nursing assistant. Christiansen gets paid by the state of Colorado to do something she has been doing full-time for the last 10 years: caring for her daughter.
Nationwide, Medicaid pays for in-home health care in some form or another in all 50 states, but in select states, Medicaid will pay relatives, like Christiansen, to care for their loved ones if that care includes skilled care that can only be administered by a certified nursing assistant. It means Christiansen now gets 35 hours of paid work per week after she completed her certification last year.
"It's great. I mean, I have CNA next to my name. This is my job. This isn't just the grunt work of being a mom," ," said Christiansen, laughing. "I take pride in that."
"It becomes very impossible to be a working parent and have a child with significant needs, so this program is a lifeline to that," added Jason Schlosky, an employee with the Personal Assistance Services of Colorado (PASCO), the group that helped make Colorado the first state to implement this paid family caretaking model in 1999.
Since then, PASCO has helped expand the program to other states like Indiana, New Hampshire and Missouri. It is currently working to expand the program even further to places like Texas and Florida, according to Schlosky, as the number of certified nursing assistants in the country dwindles.
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Certified Nursing Assistant shortage
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"I think we're going to see a groundswell in this just with what we're facing on the health care shortage," said Schlosky. "There's just not enough CNAs to care for these individuals, so for us, it just makes the perfect, logical sense to let loved ones, neighbors, uncles, aunts to care for an individual and be paid for it."
In January, the Urban Institute classified the CNA shortage in the United States a crisis. According to its report, "CNAs are the backbone of out-of-home elder care, but they're not paid well (in 2021, their median wage was $14.56 per hour). The profession itself is challenging and hazardous and has limited advancement opportunities — leading to chronic turnover and staffing shortages."
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As Schlosky sees it, the paid family caretaking model solves two problems: the income issue for families like Christiansen's who oftentimes need to give up work so they can care for their loved one, while also providing more comprehensive care.
A study published in the Journal of Pediatrics in February showed paid family caregivers in Colorado were more likely to care for the same person for at least three years than non-family CNAs (82% versus 9%), despite earning less money per hour for the same work. The study also showed the number of hospitalizations were nearly the same, indicating there is not a decrease in level of care between paid family certified nursing assistants and third-party certified nursing assistants.
"Me, her mom, who loves her the most, is there to take care of her, and she's worth fighting for, you know," said Christiansen. "Chloe is nonverbal. She can't advocate for herself, and so that's my job as her mom, as her CNA, to fight for her, and it's worth the fight."
