All about the money…except it’s not


The world of long-term care is changing. CNAs are no longer a silent workforce, an easily replaced part of the machine inside healthcare, and labeled “ass-wipers” outside. Earlier this month, CNAs around the country raised their voices together for better pay. For the most part, the response to this was positive.
And yet, there were still seemed to be some who were blindsided.
“Where’s this coming from? You said you weren’t in this field for the money!” “So I guess money is what you care about after all.”
“If you want real money, get a real job.”
Even worse, I think, are the unspoken accusations: a good, selfless CNA shouldn’t be concerned by how much money they make an hour. A good and selfless CNA isn’t in this for the money.

You see, it’s not really about the money. It’s about what the money represents: respect. Call us angels or ass-wipers, but still we are shoved under the rug, forgotten in the corner. But we do not stand alone. Behind every stressed out CNA there are 10-20 residents. People who are soiling themselves because there are not enough aides on the floor to meet their needs in a timely fashion. People are often quite aware that their needs have been placed very low on society’s priorities.

“But with the current pay and workloads, the job is still getting done!”
I hear this one a lot. It’s true, I suppose: CNAs work jobs that have pathetically low pay and where they have to care for over a dozen residents by themselves.
The workloads go hand in hand with low pay: we’re often paid a less than living wage to do the work of two or more people. But fewer people are willing to do this anymore. There’s a CNA shortage, and a turnover rate that is mind boggling…well over 50%.

So many of us work multiple extra shifts a week or struggle just to keep our families fed. It might seem an “acceptable budget measure” to keep the pay and staffing low,but I assure you, it is not “acceptable” on the reality of the floor. You cannot give from emptiness and there is little as draining as exhaustion and stress. And yet we are still expected to provided the best care or else…here come the ambulance chasers. Here come the lawsuits and state complaints.

Policy makers, I’m speaking to you personally. If you truly believe that excellent, personal care can be provided to 12+ people by an exhausted, stressed out and fiscally struggling caregiver…come be my resident. Come live in the world you have created. Come be my resident, dependent on me for everything and having to share me with 12+ other people. Tell me then that below average pay for caregivers is an “acceptable measure”. Tell me then that my residents are not worthy of enough respect to give their caregivers a living wage and good working conditions.
Tell me then that pushing for higher wages is a sign of greed; that pushing for better resident-to-aide ratios is a sign of laziness.

It’s not about the money. It’s about what the money represents: respect. Respect for me, for my chosen field…respect for the elderly and disabled that I care for. They are worthy of having a caregiver who isn’t scrapping by. They are worthy of having a caregiver who isn’t a few double shifts away from having a nervous breakdown. They are worthy of my time and they should be worthy of the money it will take to give them proper and personal care.

28 thoughts on “All about the money…except it’s not

  1. minstrel

    Last year I attended my region’s Alzheimer’s Assocation convention. One of the speakers was a geriatrian/neurologist who gave a wonderful and compassionate presentation. Afterwards I told him how much I appreciated his words. But then I asked, “What is being done, what can be done to raise the salaries of those who care for those who work in LTC homes? This very compassionate-sounding physician became defensive, almost bordering on nasty. He said, “They don’t do it for the money, caregivers aren’t in this for the money! They love their work.” I was so taken aback that i didn’t say what I wanted to: “You also seem to love your work. But would you do it for $12 or $15/hour?” I can only guess that this man was probably paid a salary in the low six figures, I think he was a department head somewhere. I can’t imagine he’d have been happy doing work the work he loved for $15/hour because he couldn’t support himself and a family on such a wage. It is time to let well-paid professionals and experts know that while we love our work, we cannot continue doing it for what we currently earn. Our wages our demeaning, insulting.

    You go, girl (May)! And all of us! If we are outraged that in our history Native Americans were oppressed, if we find it unacceptable that America’s wealth was built on the labor of slaves, we should also refuse to go along with a wage system that depends on an underclass of oppressed workers.

    1. May Post author

      Thank you for your comment! It is rather sad that people who could be pushing for change are instead making excuses for the lack of change. I’m not naive, I know that money doesn’t grow on trees and that raising the wages of CNAs to a living wage and decreasing resident to aide ratios are going to be extremely expensive. But I do still believe that a fair wage and decent working conditions are necessary for the welfare of our residents.

  2. Yang

    Bravo May! We can’t properly care for our elders without properly investing in the people who care for them.

  3. Anonymous

    Beautifully Said! I am a Cna and I love the people I care for but it’s very hard to give them the attention they deserve when being spread so thin we are the a lot more to these people, to a lot we are family because some don’t have any and sometimes only being able to give one person 20mins of your time is so upsetting. I’m glad many are speaking out for the CNA’s of the world we need a voice! It’s not about the money it’s about bettering ourselves so we can be our best and give our best to those who deserve it and need it the most and that’s very hard when stressed and over worked. Thank you for your voice!

    1. May Post author

      Why, thank you and thanks for reading! It has been a rewarding experience, being part of this blog and watching a silent workforce find its voice to speak out.

  4. Camille Stockton

    I think you said it all and very well. Working in total health care, short handed, no breaks, CNA’s calling in or no show is very stressful and a fast burn out. Sometimes it takes up to 20 minutes to answer a call light, when several more have not been anwered – some on the brink of death, others act like you are their maid. It is unbelievable what we are expected to do. We were lucky to get a 15 min. lunch hour with at least 2 hrs. overtime waiting for the next shift to show. I still have nightmares about some of the things I have witnessed or have had to do with no help. Ok I will not go on and on – though it is hard not to. Just thanks for the eye-opener-maybe it will do some good.

    1. May Post author

      You’re right, it’s easy to go on and on with the list of grievances…there’s so many of them! Changing standards, inconsistent care–you feel like it’s you’re fault and yet you know that you have done your absolute best. Thank you so much for reading and commenting!

  5. Dani M.

    I work in an AL facility where about less than 1/4 are truly independent with a bit of help. The rest is a mix of hospice, total care, and memory care. On a good day I’m in charge of 25-30. On a bad day I have 30-35, plus I’m running my butt upstairs to help my team, even giving up my lunch break, one of whom is pregnant and another who barely speaks english and is brand spanking new. Now, I’m not bragging, or trying to garner sympathy, because I don’t mind stepping up for people I consider friends. Im protective of my team and I’m tired of hearing you need to get all 9-15 showers done and get 90 people in bed in 8 hrs with 3 people, which is all we have most days. I jog from one room to the next, I call ahead and tell them how much more time till I can help them, Im drenched in sweat from this, and I force myself to make time to sit for at least 5 minutes every 2 hours even if I have lights going off and that’s only because our a/c is on the fritz right now. I’m only human. I can’t do everything. Sorry for the long rant.

    1. May Post author

      No, not at all. That’s crazy…being expected to care for 30 people on your own. There’s just no way it’s possible–and yet I know that’s the norm. I’ve been very fortunate that in my 5 1/2 years as a CNA, I’ve never had to take care of more than 20 residents, with 10 being the norm. And yet even 10 is way too much, if they’re total care residents!
      You’re absolutely right: you’re only human. Take your breaks and don’t feel guilty. You cannot take care of others if you have drained yourself completely of energy and emotion!

  6. Anonymous

    Omg yes! People don’t realize how hard we work. No, it’s not just about the money, but that’s definitely a huge part because honestly who’s going to go to work and come home exhausted, physically and emotionally without getting paid? I love my job sure, but we had to go to school for what we do. And at the end of the day of getting hit, cussed, urinated on, lifting an enormous amount of weight, and ran ragged it would be great to be paid well for what we do. That is why the shortage of cnas.

    1. May Post author

      Yes, it would be nice. More than nice, actually: it would be an acknowledgement of how hard we work and how important this job is. I believe a society can be judged in part by how they treat their disabled and elderly…not looking so good for America right now, as we can’t even pay our direct caregivers a living wage!

  7. Linda Franks

    Woo Hoo, girl! I always tell my students that they are the eyes and ears of the nurses but they won’t receive the respect nor the pay they deserve! I tell them the truth about hours, pay, and resident load. I also tell them the rewards. Many of those I have taught have gone back to factory work. Even Walmart pays more than most beginning CNA jobs! Wages and federally mandated work load need to increase.

    1. Anonymous

      I have been a stna for 28 yrs. I have read all of the previous comments and totally agree .I have done this job this long because I love doing it . It’s not the money but they do need to look at our pay and aide to patient ratio its not realistic .i personally feel guilty to take a break when I know there is some laying in a mess that can’t take care of themselves.I truly believe it takes a special person to be a stna.

      1. May Post author

        Unfortunately, that’s a choice long term care often asks us to make: do what’s best for that resident right then, or do what’s best for you (and consequently all your residents later). Tough call to make and it doesn’t get easier!

    2. May Post author

      Where I live, the expression seems to be: “I could be flipping burgers for more than this pays!”
      It’s sad, really.
      Thank you so much for your response!

  8. minstrel

    The number of and passion in the comment’s to May’s post shows how much this subject resonates with CNAs. And for every reader who takes the time to comment there are many who agree but don’t post a comment. And many CNAs just don’t have the time to read blogs. The issues of staffing ratios and wages need to be brought to those who own or operate LTC homes. CNAs: We are not alone in this! We have each other. I think I read recently that there are over a million direct-care workers in LTC homes; that’s a lot of “people power.” We do need a strategy and I think that CNA Edge is working on this. CNAs: Talk to each other about these issues. Start raising awareness that there is a growing wave of CNAs who think we must end our silence about these intolerable issues. It’s not just about us, it’s about our families and it’s definitely about our residents as well.

    1. May Post author

      I have been blown away by the response to this post. Thank you to everyone who has taken the time to share and comment!

  9. Thomas E. Mitchell

    It seems the training these days goes well beyond that of your predecessor, the Nurse’s Aide. Would your fellows accept the return of a Nurse’s Aide, to do the more menial tasks that do not necessarily require your level of training? It seems CNA’s could get the pay boost they deserve and the patient-to-caretaker ratio could still be reduced.

    1. May Post author

      Training is a funny question…I know that my own training was short (5 weeks, 2 classroom, 3 clinicals). Mostly, it was prep to pass the state test. What I learned about working the floor, I learned on the floor. Training is certainly an area that could be improved…like good body mechanics that are more than a series of drawings. Every time I train a newbie, I have to show them how to move.

      1. Thomas E. Mitchell

        Body mechanics is something I hope every CNA pays close attention to. It is perhaps the MOST important factor in keeping themselves and their patients safe. I had a rather large aide. freshly minted, nearly dump me in the floor and hurt herself during a ‘simple’bed-to-chair transfer because she ‘lifted’ instead of ‘leveraged’.

        However, I also had an aide who was barely over five feet and not very beefy that I never worried was going to dump my 5′ 11″, 150 pound frame on the floor. She knew exactly how to leverage and pivot. It was beautiful science posing as pure art.

    2. minstrel

      Thomas, I don’t think this is the answer. Because those “Nurse’s Aides” would ALSO be entitled to a living wage! It’s not that we want fancier work to justify fancier wages. We, most of us love the work we do. I don’t want to give up those “more menial tasks.” They are the heart and soul of the work–that and engaging in a personal way with every resident as we assist them with the “menial tasks.” And we don’t want to artificially over-professionalize a job / job-title, as a way of justifying higher wages. Every worker is entitled to a living wage (which I think has been calculated at over $20/hour for a single person, about $26/hour for a parent with a child. And both these numbers are probably on the low side.) regardless of how menial the work is. That menial work is essential.

      PS Many LTC homes do employ non-certified aides alongside CNAs; in some states they are required to have a certain number of CNAs per shift. I’m not sure there is much difference in wages. If aides are earning less than CNAs, they definitely are underpaid.

      1. @tmitch120

        I fundamentally disagree with your “every worker is *entitled* to a living wage” premise. There are just SO many things wrong with that ideology. And those numbers, seriously, must include a hefty budget for items not necessary to live. Perhaps the term should be “live-it-up wage”.

        Positions like these used to belong to college girls or women in two-income households. Through degradation of the economy and changes in societal norms, the percentage of two-income households is dropping and the idea of working one’s way through college has taken a beating as well.

        Back in the late 80’s when I spent my time in and out of the hospital and nursing home, I only remember one unmarried aide and she was a recent widow and new mom. She new it would be hard but, she was going back to school to become either a LVN or RN, I don’t recall. She knew SHE, not her employer, had to adapt to the change in her circumstances.

        Without a doubt, CNA’s deserve more respect. If enough CNA’s leave the workforce, or the number of new CNA’s entering the workforce drops significantly, and the supply drops sufficiently below demand, the wages will increase. Although, in my experience, it was the nurses above them that afforded them the least respect and that isn’t likely to change regardless of wages.

        1. May Post author

          Back in the day, nurses used to do more of what is called “direct care”; now, everything is shifted up a level. Nurses have become more specialized and CNAs have taken over more of the role of direct care. What we do is not assisting the nurse, like our title suggests–it is more direct patient care, hands on, ADLs and emotional support.
          Forgive me if I am mistaken, but you seem to be equating direct care to “women’s work”…if so, you are not the only one. And this is, in part, I think, part of the problem of the wages. On average, women still earn less than men in America. May I submit that this is perhaps why CNA pay is so stagnant and low? It is a job primarily filled by women…women of lower socioeconomic status as well. Why is this? In part because our society was/still is conditioned to think of “women’s work” as less important than “men’s work” and thus not needing as high a wage. As such, CNA pay is part of a larger equation, part of a larger inequality.
          As you say, the profession and the circumstances around it are changing. But the guiding rules are not. That is something we wish to change here at CNA Edge. I don’t want to “live it up”, I don’t need a fancy car or an upscale apartment. What I want is for direct care workers to earn enough income so that they do not have to rely on government welfare checks, or work so many extra shifts to provide for their children that they hardly ever see said children. What exactly consitutes this living wage depends on the cost of living in your particular area. I don’t think that the solution is a blanket wage across the country, but one that is high enough in each part of the nation for the CNAs to maintain a good quality of life–above the poverty line–so that they can, in turn, provide their residents a high quality of care.
          I’ve said it before and I will say it again: you cannot give from emptiness. And yet, this is exactly what is asked of so many CNAs around this country: give the highest quality care to your residents while you break your back and your bank trying to make ends meet.
          Thank you for taking the time to comment; I believe this is a conversation that needs to happen frankly and in the open. I am grateful for your honesty!

          1. Thomas E. Mitchell

            No, I was not suggesting it is “women’s work”. I was describing the composition of the work force. Back then there were few men in nursing and VERY few male aides. Males tended to go into the better-paying technician jobs and LVN jobs. Looking back, the one male aide I recall was the husband of a soldier.

            As for the wage gap, are you referring to the large artificial gap created by averaging wages regardless of the job or are you talking about pay variations between men and women in the same positions? If the former, there is an easy, although likely deadly, solution: prevent men from going into risky professions, and force women to, until balance is achieved.

            As for those variations in the same profession, learning to take SOME risk might help. On average, women tend to be more risk-averse than men, and asking for a pay raise is somewhat of a risk. If you look at the most successful women, or men, you will notice they are risk-takers.

            While you are very attuned to what is going on with CNA’s, regarding the low pay and who is currently taking those jobs, you may not have noticed what has happened to the industry as a whole. Over the last 40 years at least, the demographic of the entire non-elective medical profession has changed. As the pay and/or job satisfaction has dropped, the demographic has slid further down the socio-economic scale. Most of the “old white guys” that used to hold most of the doctor positions have moved on to elective medicine or other fields and been largely replaced by women and immigrants.

            Frankly, I have to assume that all of this shifting has to do with what various demographics, on average, are willing to accept and the market’s ability and willingness to capitalize on that. An immigrant, such as my son’s pediatrician, that escaped a dangerous homeland is going to be happier with current conditions than a natural born American who doesn’t have memories of persecution to remind them how good they have it.

            I don’t see an easy answer for your dilemma. As long as there is someone willing to do the job for less, there will be pressure to keep the pay where it is. Unlike fast-food employees who are pushing for the $15/hr minimum wage, CNA’s are not easily replaced by machines yet. The likely result of artificially pushing up wages would be to decrease the number of workers and further increase the work load.

            Again, there are no easy answers to the pay issue that won’t have unintended consequences. And, if there are any solutions to the respect issue beyond the petty little things aides used to do to when nurses got out of line, that’s where the best chances for improvement in job satisfaction are likely to be found.

          2. Bob Goddard

            Thomas, I know what you’re saying about supply and demand in the labor market – “If enough CNA’s leave the workforce, or the number of new CNA’s entering the workforce drops significantly, and the supply drops sufficiently below demand, the wages will increase” – but in this case the market forces are distorted. Half of all nursing home revenues are provided by Medicare and Medicaid and not subject to the laws of supply and demand. These outlays are not adequate enough to keep pace with the demand and actually keep wages artificially low. The result is a 50% annual turnover rate of direct care workers and this has devastating consequences to quality of care. The demand for direct care workers is in fact increasing and as it becomes increasingly difficult to fill vacant positions this will reach crisis proportions in the near future (for caregivers who experience this every day, the crisis is already here). To meet this demand requires significant changes in public policy.

  10. minstrel

    Believe me, $20/hr x 2080 hour/year, or $41,600/year BEFORE taxes are taken out, does not give a single person a “hefty budget for items not necessary to live.” Federal and state taxes in PA, where I live, would be about $8500, so now we’re at $33,000. FICA payroll taxes of 6.2% will also be deducted, bringing the take home pay to about $30,500 or about $2540/month. I don’t consider this an exorbitant income that supports a life lived in the fast lane. If I’m lucky I’ll be able to afford a decent apartment for no more than $1000/month, and if I”m really lucky heat and hot water will be included in my rent. This leaves me about $400/week for food, household supplies like laundry soap and toilet paper, etc., public transportation costs (because I can’t afford car insurance and maintenance), phone and electricity bills, a haircut once in a while. Not a lot left for living it up at the pub or casino. Not much bling on $20/hour for a single person, Thomas.

    Sorry but I stand by my statement that every worker deserves a living wage: i.e. enough to afford a clean place to live in a safe neighborhood, utilities, food, medical care, clothing, transportation, and yes, I consider a little extra for entertainment and a little annual vacation of some kind, to be part of what every worker needs. How can we, among the wealthiest countries in the world, justify wages that don’t allow workers to afford the basics? I think you might be confusing entitlement to a job with entitlement to a decent salary. I don’t think that anyone who won’t or can’t do a job is entitled to employment; that is a whole other discussion.

Comments are closed.