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Rethinking Nursing Assistant Jobs in Light of the Triple Threat
posted 05.12.2016

by Jodi M. Sturgeon

In the latest issue of Generations, guest editor Steven Dawson writes about what he calls the “triple threat,” a changing eldercare landscape in which increased demand for services is coming up against a restricted labor supply and declining unemployment. The traditional direct-care employment model, in which home care aides and nursing assistants have earned poverty-level wages and employers and consumers have accepted the consequences of high turnover and inconsistent quality, he argues, is no longer viable. Without higher quality jobs, the long-term care sector will experience an unacceptable level of vacancies, leaving employers unable to fill cases and families struggling to find the care they need.

Dawson’s predictions appear to be on the mark when it comes to recruiting a skilled and stable workforce for our nation’s nursing homes. The Massachusetts Senior Care Association, in a November 2015 paper, cites data showing vacancy rates upwards of 15 percent in some parts of the state. Statewide, one in ten nursing assistant positions go unfilled. As a result, the trade association launched a campaign this legislative season to increase Medicaid reimbursement rates and invest those funds in better wages and career opportunities for nursing assistants. A similar report has been issued in Wisconsin, and Rhode Island’s nursing homes are also seeking funding to stabilize their nursing assistant workforce.

A recent report from PHI, Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs, confirms that, nationally, vacancy rates for nursing assistants employed in nursing homes are on the rise after a sharp dip during the Great Recession years of 2008-2010. The report argues that low wages, along with short staffing, inadequate support, and insufficient training and advancement opportunities, make nursing assistant jobs uncompetitive in today’s economy.

Nursing assistants earn, on average, $11.51 per hour. The annual median wage is $19,000, indicating that many workers do not have consistent full-time work. One in three nursing assistants lives in a household that relies on public benefits to make ends meet.

For these meager wages, we ask nursing assistants to do some of the toughest jobs imaginable, usually under suboptimal conditions. Short staffing, exacerbated by high turnover and vacant positions, is a constant issue, forcing nursing assistants to focus on completing basic health and safety tasks rather than nurturing meaningful engagement. According to a 2011 study by S.S. Sharkey et al. published in the Journal of the American Geriatrics Society, nursing assistants have a total of 5 minutes per resident to do anything more than assist with basic activities of daily living such as bathing, dressing, eating, and ambulating. The pace of work, and sense that there isn’t time to have a real impact residents’ quality of life, drives many nursing assistants out of the field.

Efforts to reimagine nursing homes so that they are real homes, where people who need 24-hour care can continue to live fulfilling, meaningful lives are commendable. As Christine Mueller, Susan Misiorski, and Anna Ortigara describe in their Generations article, “The Role of the Nurse in Person-Centered Care,” there has been progress toward implementing person-directed care that empowers residents.  But one thing that is not considered nearly enough is the role of nursing assistants in ensuring both quality care and quality of life. What can be done to create quality jobs that attract a stable, high-quality workforce?  

Higher wages are necessary to compete for workers in a low unemployment economy. But wages are not sufficient. To retain nursing assistants over the long haul, their jobs need to provide opportunities for meaningful engagement with residents. Person-directed practices that move decision making closer to the resident can improve care while also providing a more meaningful role for the nursing assistant. In addition, nursing assistants need opportunities to learn and grow as professionals. Keeping experienced nursing assistants is key to quality care, but the best workers—those most dedicated to caring for elders--are often forced to move on to better paying jobs. Why not provide career paths that lead to better-paying advanced resident care roles, with specialties in areas such as dementia care, rehabilitation, and peer leadership?

The triple threat is an opportunity to rethink not only training and compensation for nursing assistants, but to re-imagine the frontline workforce in light of all we know about delivering quality, person-directed care. A restructured role, along with articulated career paths, could provide greater value to the system, improving job quality, providing better support and for residents, and simultaneously reducing costs associated with poor quality outcomes.


Jodi M. Sturgeon is president of PHI, a national nonprofit dedicated to improving the quality of long-term services and supports by investing in quality jobs for direct-care workers. PHI was a sponsor of the 2016 Aging in America conference.   

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