By Susan Saldibar

There’s an old cartoon by John Atkinson called “Parts of the Elephant in the Room.” It labels them as: avoidance, denial, silence, reluctance, diversion, and so forth.

Here’s an “elephant” you may be avoiding: Your CNAs. 

And yet they represent your largest employee base. They’re also the ones closest to your residents. They’re huge. And largely avoided, many of their needs denied, and suggestions met with silence.

Well, guess what. This “elephant” is about to take a seat at the big table. 

And most of it is due to one of the most dynamic, formidable (and super likeable) advocates for CNAs in the country: Lori Porter, co-founder of NAHCA (National Association of Health Care Assistants). Not gonna lie, this might be my favorite KARE-ing Conversations episode so far. Co-hosted by Jordan Evans of KARE (a Foresight partner) and our own Rachel Hill, the episode was a check-in with Lori to see what was up with NAHCA. (Watch it here.)

Lots is up. First of all, Lori was bursting with some great news:

She just took an oath of office to be on the governor of Ohio’s nursing home task force. That means … 

  • CNAs and other health care assistants’ voices have reached a level high enough to be heard and not ignored.
  • Senior care leadership can’t avoid them anymore.
  • Lori’s on a roll. And she’s not stopping.

She also talked about some programs and initiatives you need to know about:

Moving Forward Coalition. Consists of seven committees formed to address the issues uncovered in the “scathing”  600+ page nursing homes report from the National Academies of Sciences, Engineering, and Medicine. And guess what? For the first time ever, CNAs and residents are part of the committees (that’s the “big table” part). And Lori is on the steering committee to review and advise as they make progress. Double trouble, and I love it.

The Enclave Principle. This is huge. Created by NAHCA under Lori’s leadership, the model creates a distinct CNA department with their own leadership. Check out these roles and titles: An ADL specialist who is solely focused on hands-on care; preceptors, who are CNAs certified to train newly hired CNAs/TNAs; and finally, director of nursing assistants, the department head. Goals are set, and scores are given on meeting them. So at any given time, CNAs can check their scores and see the contributions they are making. NAHCA consultants help train and support the Enclave Model. And it’s been wildly successful!

NICE (National Institute of CNA Excellence). Not a NAHCA program but one Lori is involved in. It includes a full line platform for geo-targeted recruiting, enrolling, certification, and placement.

NAHCA. Up to over 40,000 CNA members and counting. CNAs’ greatest champion, NAHCA continues its work helping to improve their lives through advocacy and education. They hold the CNA Fest each year. The pandemic got in the way the last few years, but they’re back with CNA Fest 2023.

Lori Porter goes to Washington? “Give me an hour with Biden. We’ll get some things done.” 

In the meantime, Lori and her colleagues are making their own brand of “good trouble” wherever and whenever they can, putting forth their objectives and needs to CMS as well as the Department of Labor, keeping the fire lit on what they’re doing and what is needed to make improvements. Yay, Lori!

The chairman of the American Health Care Association gets it. Do you?

While speaking at a conference awhile back, he asked a group of operators how many had enrolled their CNAs in NAHCA. After counting a pathetic number of hands, he said (I’m paraphrasing), “I just came from their national conference. Eight hundred CNAs were in their chairs with pom-poms, celebrating who they are and who they care for. You own these places, and you do nothing!”

So prove him wrong:

  1. Get your CNAs registered at
  2. Register them for CNA Fest. KARE is the premier sponsor. They’re expecting 500+ this year. Make sure your CNAs are part of it.
  3. Please, please check out KARE. It has a ton of things your CNAs need. You’ll be a hero if you do.
  4. Watch the full episode, and find out what makes CNAs mutter, “Bull*#$@!”