The shrinking population of nursing assistants is a "hidden time bomb" and an impending crisis that will implode the entire nursing home system in the next few decades if drastic measures aren't taken soon, says a Cornell University social gerontologist and nursing home expert.

"With fewer young people in relation to the growing elderly population, tighter restrictions on immigration and skyrocketing turnover rates, some 90 percent of nursing home facilities are suffering from nursing assistant shortages," said Karl Pillemer, professor of human development and family studies at Cornell University and the co-director of the Cornell Applied Gerontology Research Institute. He is the author of a new report, Solving the Frontline Crisis in Long- term Care: A Practical Guide to Finding and Keeping Quality Nursing Assistants (Frontline Publishers, 1996, $39). The crisis, Pillemer says, is caused by the inability of the nursing home industry to effectively recruit and retain these front-line, "hands-on" workers. And that inability interferes with resident care, resident quality of life and facility efficiency and costs the industry millions of dollars a year.

"We not only have a serious shortage now, but by the early part of the next decade we will need 600,000 new nursing assistants," Pillemer said. He has analyzed surveys and conducted numerous focus and training groups to determine the root causes of the staff turnover and shortage of workers, and his publication offers numerous solutions.

"Many nursing assistants begin with a sense of enthusiasm, sound intrinsic motivation, a desire to help others and a sense that he or she is making a meaningful contribution, yet workers get burned out, not only by stressful conditions and heavy workloads but also because of a lack of recognition and respect," he said.

Among his practical suggestions for nursing homes: -- Interview departing employees to determine why they're leaving and periodically survey current staff.

• Enlist staff in finding potential co-workers.
• Promote the job as one that makes a difference.
• Prepare a positive orientation program to set the tone for the future of the employee. Design a buddy system so the novice employee can work with a seasoned one. -- Institutionalize ways to recognize good performance, which will boost morale.
• Organize voluntary, peer support groups to help nursing assistants cope with their job pressures. -- Develop career ladders that might include technical training with a formal graduation, new job titles and increased responsibilities.
• Train supervisors to provide flexibility, feedback, a ready ear and a willingness to include nursing assistants in care planning and decisions regarding their work.
• Provide continuing education trainings in ethical dilemmas, conflict resolution and communication with families.

"The key here is treating nursing assistants with respect, not as replaceable, unskilled labor, because they are neither," stresses Pillemer. "Studies have shown that probably the most important thing in residents' overall well- being in a nursing home is their relationships with staff. And nursing assistants provide almost 90 percent of all the care residents receive.

"It's not an exaggeration to stress that we will shortly be in a crisis situation regarding nursing assistants. We must act now to better recruit and retain these essential, front- line employees," he added.

"The continuing failure to stabilize and develop nursing assistant staff threatens all that providers have accomplished in improving quality, as well as all their best plans for the future," says Richard Hoffman, editorial director for the new book and editor, with Pillemer as executive editor, of Nursing Assistant Monthly, a professional newsletter for nursing assistants. "In long- term care, we have more than money at stake. We're talking about how we care for the most vulnerable members of our communities," he warns.

"This book is inspirational and thought-provoking; it's solidly grounded in research and real-world experience and packed with pragmatic tips," said Elise Nakhnikian, editor in chief of Contemporary Long Term Care.