Opinion: Policy Changes Critical for Long Term Care

In October 2025, I read about a CNA in another state who was arrested after a resident suffered a fatal injury during a transfer. What stood out the most about this situation was not just the incident, but the situation the CNA had been placed in—forced to choose between neglecting a resident or attempting a 2 assist transfer alone due to understaffing. That is a decision CNAs face every single day, and instead of holding those who created this awful situation accountable, responsibility fell on the staff with the least power to change them.

That same day at work, I saw my own environment differently. One resident told me that he avoided asking to get out of bed because staff are overwhelmed and he didn’t want us to get in trouble if we weren't able to do it. Another said he hesitated to use his call light for the same reason. A newer CNA quietly asked me for help but admitted she was afraid to ask others because management had told her she shouldn’t need assistance. I also watched a coworker struggle with not having time to comfort a dying resident because staffing levels made it impossible. Residents should not feel like a burden, and caregivers should not be afraid to ask for help.

As a Certified Nursing Assistant working in Indiana, I have seen firsthand how gaps in policy, oversight, and enforcement impact both nursing home residents and the workers who care for them. These are not abstract issues—they are daily realities in long-term care facilities across our state, where vulnerable Hoosiers depend on safe, consistent care and frontline healthcare staff are asked to meet those needs under increasingly unsafe and impossible conditions.

In my experience across multiple facilities, I raised concerns when I witnessed unsafe practices that could result in harm to residents or staff. These included being instructed to perform tasks without proper equipment or the staff needed for the tasks to be done safely, creating a serious risk of injury. Over time, speaking up led to retaliation. I was disciplined for issues others were not, falsely reported for incidents that never happened, given extra work, and ultimately terminated after I began advocating more formally for improved working conditions, including organizing efforts. Under current laws, workers in Indiana often have limited immediate protections in these situations and are expected to rely on lengthy, long drawn out, administrative processes that can take months on end and sometimes upwards of a year or longer.

This environment contributes to a much larger problem. Many CNAs and nurses are afraid to report these unsafe conditions. I experienced this directly when I filed a complaint with OSHA regarding insufficient mechanical lifts—equipment that is essential for safely transferring residents. Rather than conducting an on-site inspection, they relied on my employer to confirm or deny the accusations, and my concerns were dismissed without anyone stepping into the facility. When oversight functions this way, it undermines trust and discourages workers from coming forward, even when serious risks are present.

There are also systemic practices that weaken care standards. In many facilities, care plans do not accurately reflect the level of assistance residents require, which can be used to justify lower staffing levels. At the same time, staff may be told they cannot refuse assignments, even when the task could result in injury to themselves or residents. This creates an environment where workers are forced to choose between their own safety and their livelihood, and where residents ultimately receive less attentive care.

Regulatory agencies need to be required to conduct thorough, on-site inspections when serious complaints are filed. Oversight cannot rely solely on communication with facility management and some expectation that they'll be honest and admit to the issues.

We also need enforceable staffing standards that reflect the actual needs of residents. At a minimum, penalties for neglect caused by poor staffing must exceed the cost of sufficient staffing. As long as it remains cheaper for corporations to operate with insufficient staff and pay fines after the fact, unsafe conditions will persist. Corporate ownership groups that implement policies leading to chronic understaffing should be held accountable for the outcomes of those decisions.

Another major problem is the diversion of Medicaid funds being done by public entities that have purchased facilities to gain access to the extra Medicaid funding then diverted large portions. We need laws to prevent this from continuing, if money is being provided for the care of our residents then it should be required to go to the nursing homes and be used on their care.

Finally, we need to strengthen whistleblower protections for healthcare workers. CNAs and nurses are often the first to recognize when something is wrong, but too many stay silent out of fear of retaliation. Protecting those who speak up is essential to ensuring that problems are identified and addressed before harm occurs.

Our residents deserve to have their care, safety, and dignity placed above profits. Staff shouldn't be afraid to advocate for their residents rights or their own rights. We need a system that holds those in charge accountable for consistently placing profits above everything, including the lives of the people they're meant to be protecting.