Can free tuition solve California's caregiver shortage?
One of California's largest senior living facilities has a new solution to the growing shortage of certified nursing assistants, who provide basic care to older patients.
When Analynn Mausisa learned in January that her employer, the San Francisco Campus for Jewish Living, was offering workers like her free tuition to become a CNA, she jumped at the chance.
At the time, Mausisa had been working for about a year as a safety monitor at SFCJL, helping residents get to and from doctor's appointments. But she had no direct patient care experience, which she knew she needed to advance in the health care field.
"I wanted to improve myself professionally and create better opportunities for me and my family, to provide better income," said Mausisa, 50.
Mausisa is one of 13 newly certified nursing assistants in SFCJL's first cohort to complete the 200-hour training and pass state certification exams in May. SFCJL paid for the training and exam fees, which otherwise would have cost about $2,000 to $2,500, as part of an effort to get more CNAs in the workforce.
The shortage is largely driven by demographics: The number of U.S. adults 65 and older is growing rapidly, while the caregiver workforce has high turnover, especially after COVID. California is projected to face a direct care worker shortage of 600,000 to 3.2 million by 2030, according to the state's Master Plan on Aging. The effects will be acute in the Bay Area, one of the fastest-aging metropolitan areas in the country.
Skilled nursing and assisted living facilities have been grappling with the shortage for years and experimenting with ways to incentivize more caregivers to enter and stay in the field.Many of those efforts focus on CNAs, as more than half of CNAs in California serve older adults in nursing or community-based settings.
"There aren't enough people to fill these roles, and high turnover," said SFCJL CEO Dr. Adrienne Green. Many similar organizations have opened their own schools, she said. "The idea is people go through a training program, get a CNA certificate and there's a guaranteed job at the end of it as a way to help people launch their careers."
Green hopes that the program will help maintain staffing, and that many will stay on and progress to become licensed vocational nurses or registered nurses, which require more training.
SFCJL's free CNA training program is the latest, but not the only, initiative to try to bolster the caregiver workforce, which has historically been plagued by low wages and demanding physical and emotional work.
In 2022, LeadingAge California, a Sacramento advocacy group that represents aging services providers, launched a three-year program to recruit, train and employ new CNAs and home health aides in California.The program covered full tuition fees for students and was funded by $35 million in grants from the state Department of Health Care Access and Information and Department of Aging.
The program, which ended in July 2025, trained 6,200 people. About 3,500 passed the CNA certification exam. It also offered bonuses to graduates to stay at a caregiver job for one month, six months and a year.
The organization has the infrastructure and capacity to continue the program, but does not have enough state or private funding to relaunch it.
"We've got a long way to go to make sure there are sufficient workers to care for older adults," said LeadingAge California President and CEO Jeannee Parker Martin.
CNA training includes learning how to help residents with activities of daily living, such as bathing, getting dressed and going to the bathroom. For SFCJL's program, the classes and clinical components, like learning how to operate lifts to transfer residents from their bed to a wheelchair, were all done on-site at the SFCJL.
Funding for the tuition came from donors and a grant from the California Association of Health Facilities, a nonprofit trade group that represents skilled nursing facilities.
Mausisa had already been thinking about starting a CNA training program, but kept putting it off because the prospect of going to school on top of her job felt daunting. Having the training on-site and being paid for her time - she continued to earn her security monitor salary during CNA training - helped make it more convenient.
"It helped me financially because it's free and it saved time," Mausisa said. "I get significant benefits for my career and I have a secure job."
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