For years, a crisis has been brewing in the nursing home industry where certified nursing assistants have received low wages and poor/no benefits while providing care to their residents. Many of these nursing assistant jobs require the employee to work erratic hourly schedules for poor benefits, little pay, and usually no opportunity to advance in their career. These jobs have been associated with high injury rates and high turnover.
Approximately 50% of all nursing assistants in the United States live well below the federal poverty level. Low pay often results in the need to work longer hours, which could cause fatigue and place the resident’s health in danger. The problem with underpaying and understaffing is likely to increase significantly in the years ahead, as the last of the baby boomers enter their retirement years, and the need for additional nursing home beds rises.
According to the US Bureau of Labor, the number of nursing home workers across America has doubled over the last decade with many more jobs likely available by 2024. Statistics show that the population of Americans over 85 years old will likely be doubled by 2030 where most will require some level of professional skilled nursing care at a facility or in their home.
When Congress enacted the Affordable Care Act (ACA), Medicaid expanded far beyond its previous borders after the government provided more funding for caregiving. Unfortunately, the need for higher wages did not increase like the growing need for more workers in the nursing home, rehabilitation center, and assistive living industries.
According to a report released by the Paraprofessional Healthcare Institute (PHI), “as a result of poor-quality nursing assistant jobs, vacancies are growing, and turnover is high, undermining the continuity and quality of care for nursing home residents.” The author states that the high turnover rate is likely the result of ineffective or nonexistent employee training and the lack of opportunities to expand their professional career.
PHI recommends that nursing home care providers “raised the floor” by offering nursing assistants competitive wages, consistent shift schedules, and health insurance in a job that provides full-time employment with minimal need for working overtime. The report also states that “to attract and retain nursing assistants, policymakers and employers alike need to envision how these jobs become a family-sustaining career comparable with those in other industries.”
Over 1.7 million individuals in the United States live in approximately 17,000 nursing facilities. The federal government released findings from a research study that showed that less than one of every ten nursing homes employ the ideal number of Registered Nurses, Licensed Practical Nurses, and Certified Nursing Aides. That said, many of these facilities are never cited by federal authorities for understaffing, overworking, or underpaying their employees. This is because government standards are set so low as to not attract the qualified, trained workforce to ensure that every resident receives the highest quality of care.
Low Pay Creates Serious Consequences For Patients
Some reports by the nursing industry correlate nursing home abuse with understaffing, often because the staff members are underpaid, overworked, feel unappreciated, and are more likely to display abusive behavior to residents in the nursing facility because they are tired and frustrated. Some believe that the nursing home administrator, manager, or owner intentionally understaffs the facility to reduce labor costs and generate greater profits.
In some situations, the nursing home may be experiencing serious management problems where they cannot find or keep the right number of adequately trained nursing staff and certified nursing aides with to provide all the necessary nursing care and hygiene assistance that every resident requires. The high turnover in the employment of nursing home workers might be the result of over-scheduling when Certified Nursing Aides, Licensed Practical Nurses, and Registered Nurses become overwhelmed, tired, and fatigue when performing their duties.
The need for the existing staff to work extensive overtime hours is a serious factor in some of the problems in providing care to nursing home residents. Making staff members work long hours can quickly contribute to the unacceptable dynamic that compromises the level of care they provide. Any negative consequences occurring at the facility associated with nursing home workers that are overworked or underpaid can affect how the resident’s needs are met. Doctors, nurses, Certified Nursing Aides, and other nursing home workers might suffer the severe consequences of excessive stress on the job which could lead to nursing home neglect, mistreatment, or abuse. Too many patients and too few staff members can create an unsustainable staff member-to-resident ratio and cause uncontrollable chaos where safety and maintaining the resident’s well-being goes out of control.
Studies show that nursing home residents who have been abused or neglected develop psychological and psychosocial problems, physical illness, mental distress, and even death. A lack of necessary staff members tend to increase the stress levels of employees and residents who often become victims of mistreatment. Overworked and underpaid nursing home workers usually cannot get their work done on time. The confusion and fatigue by the staff members usually create an environment where substandard care becomes the norm when residents’ needs are not tended to by competent employees. A lack of quality care can lead to serious problems including contagious infections, life-threatening bedsores, illness, disease, and residents living in a filthy, unsafe environment.
Neglecting the Resident’s Needs
Every resident in a nursing facility entered the home because their health required them to receive care from others who would manage their health, administer medications, and maintain the resident’s daily activities including grooming, bathing, and eating. Unfortunately, many families place the care of their loved one in the hands of underpaid and under-appreciated nursing home workers who can barely survive on the money they’re paid to provide care. Sadly, serious health problems can arise when the staff does not meet the resident’s needs on a regular basis. The resident might not receive their medication on time or at all, become malnourished or dehydrated, or receive improper medical care, which could lead to their unexpected demise.
Patients who require the highest level of medical attention including those who are immobile or require assistance with transfers pay the biggest price. The nursing staff is required to ensure that the resident eats, drinks, and toilets. These patients must be repositioned at least one time every ninety minutes to alleviate pressure on their skin and minimize any potential chance of developing a life-threatening bedsore or dangerous infection.
However, nursing home workers who feel unappreciated or are burdened with understaffing or low pay often find it impossible to provide every resident individualize care. In many nursing homes, the administration provides insufficient supervision to staff members to ensure patients’ basic needs are met. In some cases, without adequate monitoring by a competent staff, the resident can easily wander away from the facility unnoticed.
Underpaying workers for performing grueling physical labor is a problem even in good nursing homes where the employee struggles to provide an acceptable level of care for a resident who lives much longer than their parents did just a few decades ago. However, it is the neglect, mistreatment, and abuse that occurs in bad homes where the resident’s needs are not met because of unanswered call buttons or festering pressure wounds.
Other residents are abused or neglected because of inexplicable mistakes when administering drugs or a lack of attention when the resident needs their caregiver most. Many of these common problems go uncorrected because the nursing home has suffered minimal repercussions for years. Typically, changes are made only when inspectors, surveyors, and investigators from state and federal nursing home regulatory agencies arrive unannounced to survey what is going on, investigate formally filed complaints, and force the nursing home to comply to make changes immediately.
Will the Problem Never Be Corrected?
According to the US National Institutes of Health (NIH), certified and non-Certified Nursing Assistants make up approximately 90% of the workforce in most nursing homes across the United States. However, their wages are often half of what Registered Nurses and Licensed Practical Nurses receive for providing direct care. Most of these workers have completed dozens of hours of training and hundreds of hours of on-the-job training to receive their certification.
Unfortunately, many of these nursing home workers receive most of their education where they work; where there is likely no uniformity in training or any required “staff-to-resident ratio,” which likely ingrains how to provide the resident substandard care. The NIH released a study that explored the way that Certify Nursing Assistants “make meaning of their work despite devaluations such as a lack of respect for management and residents, and the physical and emotional demands of such low-status work.
CNAs’ meaning-making represent an effort to assert a positive identity rather than accept the stigmatization associated with their work. Assertions of the value help CNAs reconstitute their identities. Assertions of meaning, which depend upon providing good care to residents regardless of financial reward or management respect and support, make CNAs vulnerable to exploitation.”
The crisis will likely not be corrected soon because many nursing facilities still have high employee turnover, low wages, and heavy workloads that supports a popular public perception that caregiving in nursing homes is not good enough for their loved ones.
Some major nursing home caregiving corporations are taking steps to improve their professional standards by mandating that every nursing aides participate in a standardized, uniform, professional training program away from the facility, preferably at a community college or other professional education program. The crisis may improve if we promote and fund nursing home workers, especially certified nursing assistants as a medical profession that offers enticing incentives to advance in their career rather than offering work as a grueling job that most anyone could perform.
Only then will the nursing home be able to recruit, train, and keep qualified staff on hand to ensure that the residents’ needs are being met. For over a century, families have perceived nursing homes as the curse of the healthcare industry, even though many nurses and nurses’ aides remain committed and dedicated to the cause of delivering the highest standards of care to the disabled, infirm, and elderly.