Category Archives: low pay

Long Term Care’s “Trans” Issue




When the issue of CNA wages is raised, the response is never “Sorry, we don’t think you deserve better wages. We’re not going to pay you enough to live on if we can get you to work for peanuts.” No: administrators will say, “Yes, we know aides are worth more and we would love to pay higher wages. We just can’t afford to. The money isn’t there.”

Are you sure about that? Show me the money. Let us see your budget. Every organization has a budget, detailing what comes in and what goes out and where it goes. Long-term-care administrators tell us they can’t find the money to increase wages or benefits of aides. Maybe so, but we aides would like to be included in the search.

This is about transparency in money matters. If you attend conferences and webinars and read articles on how to achieve quality care in long-term-care homes, you will often hear the word ‘empowerment.’ Residents need to be empowered. Persons living with dementia need to be empowered. And direct-care workers need to be empowered—that’s what the experts say. What could be more empowering than having a say in how money is spent? Including aides in a transparent discussion of resource allotment would demonstrate trust in us, respect for us, and appreciation for the creativity we might bring to problem-solving. There may not be a wealth of money being wasted or misspent. But aides are in a unique position to see opportunities for cost savings that others might overlook. As a CNA I saw the amount of food that, at the end of every meals wasn’t in the stomachs of residents but in black plastic waste bags. I saw the wastefulness in our use of disposable items like plastic cups, paper plates and napkins. Without impacting the welfare of residents, aides might find multiple ways of cutting costs so that money might be re-directed. We might bring fresh vision to decision-making about saving and spending. Give us a chance!

Perhaps administrators protect budget secrecy out of embarrassment over the wide gap between the salaries of aides and the salaries of the executive and managers. Or out of worry that this knowledge might lead to poor morale and workplace unrest. Maybe the organization worries about privacy rights; why should anyone’s salary be public knowledge? First of all, budget transparency doesn’t mean that individuals’ salaries have to be known. (However, if it did, would this be so bad? Americans are more open about their sexual practices than about their finances! We know the salaries of the President and members of Congress and of the CEO’s of publicly-traded corporations. It is a tool of accountability.) There are ways to protect information about individual salaries (as the federal government does for federal civil servants) while making information available about salary ranges, the percentage of the budget spent on various classes of jobs, etc. This privacy issue is an excuse, a ploy to halt discussion before it starts. It’s not a justification for saying no to transparency.

Aides aren’t children. We’re capable of understanding issues, of being reasonable. We can understand that some positions merit higher wages than others and that some employees will deserve to earn more than others. We can be patient about wage increases. But we shouldn’t be shunted off to the side when budgets are discussed, as if we were just another piece of mechanical equipment in the workplace. We need to breach this wall that seems to create a ‘them’ and an ‘us,’ the intelligent responsible people on one side and lower class workers on the other. We are all part of the care community; we all want to improve it. One way to do this is to make budgets more transparent. If we want to retain employees and attract new job seekers, salaries and working conditions must become more appealing. I suspect that money might be found to do this, if budgets were transparent to all stakeholders.

We hear a lot about the need for culture change in long-term care. Budget transparency is a culture change issue that we don’t hear about yet. Let’s hear a call for transparency from the leaders of the culture change movement. Let’s hear it now!

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.

Why are CNAs so Poorly Paid?





This week there has been a lot of talk in the media about the movement to raise the minimum wage to $15 an hour.  While most of the attention was focused on fast food workers, advocates for direct care workers took the opportunity to highlight the negative impact that poor wages have upon caregivers and their residents. In a Wednesday article for McKnight’s, Matt Yarnell, the Executive Vice President of SEIU Healthcare Pennsylvania, pointed out that nearly one in six of the state’s nursing home workers are paid so poorly that they are forced to seek public assistance through the Supplemental Nutritional Assistance Program, Medicaid or both.

Yarnell wrote “If we are serious about providing the highest quality care for our residents, then we have to back our rhetoric with action. It means we have to provide living wages to caregivers to cut down on turnover, to not force caregivers to work excessive overtime and double shifts. It is about not forcing workers to have to look to the state for public assistance to provide for their families.”

Why are direct care workers so poorly paid? A common argument points to the low educational requirements necessary to work as a caregiver. Often this point of view comes from within the Long Term Care community itself.

It’s true that the technical skills of a caregiver can be taught relatively quickly. Things like the principles of basic hygiene, taking vitals, infection control practices and proper body mechanics are pretty straightforward and don’t require a lot of advanced study. However, while formal training serves to create a basic necessary skill set, the real education for a caregiver doesn’t begin until he or she starts working with residents and fellow coworkers. The art of caregiving is learned through a combination of practical experience and mentoring from other workers. For those open to it, this is a learning process that can last the duration of one’s caregiving career.

The real value of experienced caregivers cannot not be found in their technical skills – or in anything that formal education could provide. Rather, it is in their capacity to perform well under difficult – often unreasonable – circumstances without losing their basic sense of humanity. It can be found in their ability to engage residents on an emotional level while under the duress of constant time restraints. It can be found in their willingness to support and sometimes lead their fellow coworkers in an environment that lacks adequate formal supervision. It can be found in their desire to serve as an example of how one human being should treat another without regard to roles or circumstance.

Good caregivers have a monetary value to the Long Term Care industry beyond what their technical skills and education can provide. The industry could not exist in its present form without their effort and caring. CNAs are truly the backbone of LTC. And their heavy lifting does not always involve transferring a resident.

The real reasons why caregivers are so underpaid are rather complex and go beyond educational requirements or even greedy nursing home operators. It is a very real social problem with direct implications to the well-being of our elderly and disabled citizens and should be treated as such.