Salary matters in long-term care

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Elizabeth Newman
Elizabeth Newman

The University of Pittsburgh's research involving certified nursing assistants and why they leave is among the most interesting I've seen recently in long-term care. Salary, it turns out, is not nearly as important as respect and flexibility in scheduling.

Which is worthwhile to keep in mind when looking at the recent fight in Pennsylvania to have nursing home workers make a living wage. They're fighting for $15 an hour; a recent report says the median for nursing assistants is $13.01 an hour.

That's $27,061 annually for a full-time nursing assistant. Dietary and housekeeping workers earn $10 to $11 an hour. Salary might not be the deciding factor, but it certainly influences where people go.

To give some context to salary in a low-paying field, when I accepted my first full-time newspaper job in 2003, I made $29,000. Granted, I went to a fancy-pants journalism school, but seriously, it's the newspaper business. It's an industry that so underpays its workers that a just-announced Pulitzer Prize winner left last year for a job in public relations. He said he couldn't make his rent otherwise.

Before you accuse me of getting too far up on my high horse, let's return to that Keystone Research Center report, which said 14% of nurse aides in Pennsylvania and 28% of dietary workers in nursing homes say they or someone in their family receives public assistance.  

The problem is nursing home employees are working for an industry reliant on Medicare and Medicaid, leading one researcher to declare taxpayers are the ones being socked.

“This means taxpayers are, in many cases, ‘double‐subsidizing' poverty jobs in Pennsylvania nursing homes,” said Stephen Herzenberg, Ph.D., an economist and KRC executive director.

Fighting words, I know. The report says a $15 minimum wage at the state's nursing homes would help close to 50,000 workers — and increase overall nursing home costs about 4%.

There are some who suggest this is impossible. Giving $13 or $14 an hour to aides would mean cutting benefits, or it isn't feasible given the portion of Medicaid residents, the skeptics say. Other executives say it's not their fault their company can't provide higher wages, but rather it is due to the high cost related to government regulations, lack of Medicare reimbursement, etc.

Fine. Only you and your CFO truly know the intricacies of your finances, though I urge you to realize that if your CEO is making $18 million a year, it's not going to look great to the public, or your workforce. Also, the industry tends to look only at the pure costs of wages and ignore the cost of turnover. Providing living wage is only one part of a larger financial picture in long-term care, and even if you can't raise salaries, I ask for you to consider two points.

The first is the idea that, because long-term care is a noble calling for many, we believe spiritual fulfillment compensates for a lack of salary. It's a lot easier to believe this when you can afford to feed your children. There are often not a lot of options for those trying to make ends meet — witness the nursing home dietary aide worker reprimanded for taking home leftovers, whose own children were on food stamps.

The second is around the concept that the playing field in our industry is equal. Of course those who pursue more education can expect higher wages. But many long-term care administrators, directors of nursing and chief executive officers were able to pursue college or higher-level degrees because they grew up ensconced in privilege. This doesn't just mean they necessarily came from upper-class families, because many of them didn't, but they may have had stable families, or a good high school, or mentors, or a scholarship, or something that helped them rise in the ranks. No one succeeds completely on his or her own.

All of which is to point back toward embracing empathy, the idea that even if you cannot raise your aide's salaries, you can realize why they are there. Like you, they want to be a productive member of society. Like you, they believe in the mission of long-term care. And like you, they are hoping hard work will create a better life for their families.

Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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