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LTC Bullet:

The Plight of Certified Nursing Assistants

Wednesday May 12, 1999


Amidst the hullabaloo of arguments over how to finance long-term care, a key element is often lost: what is the quality of care seniors currently receive in nursing homes? How much attention do they receive each day? And what about the caliber of nursing home staff? As this Bullet points out, protecting your assets isn't the only reason to purchase long-term care insurance.

They rise before the crack of dawn or work through the night. They help elderly people eat, dress, bathe, and use the toilet. Sometimes they're hit, scratched, or yelled at by those they serve. Yet on average, they earn just $7.44 per hour. They're Certified Nursing Assistants (CNAs) staffing our nation's nursing homes 24 hours/day, 365 days/year. The vast majority of them will quit within one year; those who remain love the work in spite of the lack of gratitude, lousy pay, hard work, and short staffing.

The May issue of Contemporary Long Term Care magazine focuses on the plight of Certified Nursing Assistants working in nursing homes. Following are some excerpts from those articles and interviews.

"When Maria [Vasquez, CNA of 28 years] rises before 4 a.m., Poudre Valley Trailer Park is dark, and it will be dark before she returns home…. [Maria] bundles her sleepy… son into the car… and heads to work as a certified nursing assistant…. It's a 10-mile drive…, but Maria can't afford rent in the booming university town….Maria leaves her children in town with her mother."

"Maria is helping Emma dress when pool aides ask for help with an incontinent man…. As [Maria washes him], she asks if he's getting hungry, and monitors care another aide is giving the roommate. 'Usually he hides his comb in the top drawer,' she calls out. She also calls the aide's attention to the resident's swollen foot."

"The hardest part is when you don't have enough help. You can't give the care a patient needs because there are only eight hours in the day. [After subtracting break time]… that only leaves you 28 minutes per patient, and that's to bathe them, feed them, make their beds, brush their hair, brush their teeth." Betty Brewer, CNA for 51 years

"I don't know if you realize what a great need there is with nursing home people. I have several residents now that, if it wasn't for the aides, wouldn't have friendship or love and understanding, because the families are not there." Margaret Fletcher, CNA for 52 years

"[At the end of her day] Maria has walked nearly three miles, cleaned four fecally incontinent residents, stood for all but an hour, and lifted thousands of pounds. She's fed, washed, wiped, comforted, kissed, cleaned, and charted. And now she has 12 minutes to change her clothes, get to her next job, and do it all over again."

Why do CNAs work so hard and earn so little? According to William Painter, a long-term care consultant writing for Contemporary Long Term Care, it's basic economics:

"The reimbursement from Medicaid and Medicare forms the base of most facilities' operating budget; in some, it's the whole shebang. Therefore, meaningful upgrades in the wage levels for nursing assistants in long term care are not going to happen unless there is some kind of upward adjustment to reimbursement rates."

Medicaid typically pays only 80% of the private pay rate; often, it fails to cover the cost of providing care. If reimbursement rates fail to cover the cost of a patient's stay, how can nursing homes fund enough quality staff? What are the incentives for good staff to stay?

Current fiscal reality ensures that Medicaid will continue to face extreme financial pressures. The nursing home industry can substantially increase revenue only by growing the number of private payers. How? One important step is supporting public policy that encourages people to plan ahead with long-term care insurance.