April 22, 2022

After completing an intensive five-week training program in November, Nadege Massillon found a good job at a nursing home in Norwood.

The position she accepted promised steady hours, decent benefits, and a likely pay increase to more than $20 an hour once she passed her exam to become certified as a nurse aide, or CNA.

Massillon, 40, of Dorchester, felt confident and well prepared to take the 90-minute exam after her training. But for almost six months she’s been unable to schedule a test.

That’s because the private company recently hired by the state to administer the test has offered very few test dates in the first months of its contract.

“It’s been really frustrating,” said Massillon, who paid for the test months ago. “I just want to take the test and get it done.”

Massillon’s completion of her training coincided with the hiring by the state of a Maryland-based national testing firm called Prometric. In the first months after Prometric took over the state contract, testing ground to almost a complete halt, as the company looked for sites at which to conduct its tests and staff to proctor them.

In February, Massillon thought she had finally succeeded in getting a test date in a call to Prometric. But, ultimately, the exchange she had with a company representative that day left her feeling even more deflated and frustrated.

Massillon was optimistic at first in that call because the Prometric representative quickly rang up $110 on her credit card for the test. But after Massillon put away her credit card and asked for the date, time, and place of the test, she said she was stunned when the representative told her there were no tests scheduled at that time.


“When will one be scheduled?” she asked.

The company representative said that she didn’t know, and that Massillon would have to call back.

Massillon, a Haitian immigrant, takes classes toward earning the equivalent of a high school diploma at the Jamaica Plain Community Center Adult Learning program. She’s also a mother raising small children. One of her teachers, Johanna Littlewood, had volunteered to help Massillon, and was on the call with Massillon when Prometric charged her $110.

“That’s a lot of money without getting a test date,” Littlewood said.

Massillon and Littlewood repeatedly called Prometric, they said, but hung up after about 30 minutes of waiting on hold. Finally, on April 11, determined to get through, Littlewood waited on hold for 90 minutes.

No one picked up.

“Nadege is trying so hard, but she keeps hitting brick walls,” Littlewood wrote in an e-mail to me.

CNAs are the folks who do the unglamorous work of caring for vulnerable elders in nursing homes. They help patients with eating, bathing, grooming, mobility, and other tasks, and they take and record their vital signs.

There are now almost 20,000 CNAs on the job in Massachusetts, the vast majority of them women, many of them immigrants of color. And the state is in severe need of more CNAs. It’s one component of the ongoing medical staffing crisis, which has its roots in pandemic burnout.

About 4,200 additional CNAs are needed — a 21 percent increase — to meet existing needs, according to one industry estimate.

There are about 200 programs for in-person training for CNAs in Massachusetts, including those operated by training centers, community colleges, labor unions, and nursing facilities. Fees for training run as high as $1,500 and are sometimes subsidized by employers — as was the case with Massillon — or by the state.

For many years, the Department of Public Health, which oversees CNAs, contracted with the American Red Cross to run the exams, but the Red Cross notified the state in August that it was ending its testing program, effective three months later.

The state hired Prometric as a replacement. But the transition has been rocky, according to Tara Gregorio, president of Senior Care Association of Massachusetts, which represents about 320 nursing facilities.

“The lack of testing is really alarming,” Gregorio said. “Prometric is making progress, but it has been slow.”

Gregorio said a survey of nursing homes revealed that at least 1,000 trained nurse aides are currently awaiting testing. At the same time, nursing homes are turning away patients being discharged from hospitals because of staff shortages, she said.

“I know testing is a priority at DPH, and I appreciate that, but more needs to be done,” Gregorio said. “The need is acute and urgent.”

Jodi Francis, director of the training program in Brockton that Massillon attended last fall, said Prometric now has a growing number of testing sites up and running, but more are needed.

“It’s definitely a problem that needs to be addressed,” she said. “I know DPH and Prometric are trying and making an effort.”

Francis said she remembers Massillon as a highly motivated student at Health and Home Care Training of New England. She said a high percentage of her students are immigrant mothers without high school diplomas.

“It’s a stepping-stone for many of them,” she said. “They are trying to better themselves. Some go on and get nursing degrees.”

DPH, in response to questions, said it is working with Prometric to modify some protocols to add more testing sites more quickly.

DPH said it also asked Prometric to “reach out” to people “who may be waiting to schedule an examination.”

Prometric said it has tested about 550 candidates for certification since coming on board, but that there are several hundred people like Massillon who have paid their exam fee but still have no test date.

“We recognize there are improvements to be made,” Prometric said. “We are working diligently to expedite the process for all involved.”

“We greatly appreciate [their] patience as we continue to ramp up our service,” the statement said.

(After I got involved, Prometric contacted Massillon and scheduled an exam for her in May.)

I recognize that DPH, now in its third year on the front lines of the battle against COVID, has plenty of demands on it. And I know it can’t be easy in these times for companies like Prometric to quickly get a large testing program up and running.

But the wait has been too long for folks like Nadege Massillon, whose work on behalf of the elderly deserves only encouragement and appreciation.