Underpaid nursing home aides lead to poor care, group says

Nearly one in three nursing assistants rely on public benefits, according to PHI
Nearly one in three nursing assistants rely on public benefits, according to PHI

Low pay and poor benefits for nursing assistants is resulting in a “crisis” of low quality care in nursing homes, according to a report released Tuesday by the Paraprofessional Healthcare Institute (PHI).

Nursing assistant jobs are often characterized by poor benefits, high injury rates, erratic scheduling, high turnover, few opportunities for advancement and low pay, the report asserts. Nearly half of nursing assistants live in households below 200% of the federal poverty level, with one in three assistants relying on public benefits.

“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 report's authors wrote.

To remedy the issue, PHI argues that providers need to “raise the floor” for nursing assistants and support staff by paying competitive wages, providing health insurance and creating consistent shifts with full-time hours. The profession's high turnover rates may also be stemmed with better employee training, support and opportunities for professional growth, the report's authors added.

The issue could also benefit from legislative action, PHI noted, including minimum wage increases, greater transparency and requirements that a certain percentage of reimbursements be directed to wages for frontline workers.

“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,” the report states.

In response to the PHI report, officials with the American Health Care Association and LeadingAge agreed that greater investment into the nursing home workforce is needed, but that the resources aren't always available to retain CNAs.

“We have made turnover and retention of staff as part of our quality initiative given the importance of attracting and retaining the best personnel for the job we do,” David Gifford M.D., AHCA senior vice president, said in a statement to McKnight's. “Unfortunately, given that nearly two-thirds of residents in our centers are on Medicaid — and the program underfunds long-term care about .88 for every dollar in care we provide — this reality limits the ability of our members to recruit and compensate CNAs the way we want.”

LeadingAge officials are addressing workforce issues through legislative efforts, according to a statement to McKnight's, but the group reiterated that the issue primarily lays with federal reimbursements.

“The plain fact is that nursing homes' ability to improve pay and benefits depends on revenues received from the public programs which finance 70% of care nursing homes provide,” the statement reads. “There is general agreement among all stakeholders that most states under-reimburse for costs of care, even with the relatively low rate of wages and benefits nursing homes currently are able to pay.”

While employee pay and benefits are widely recognized by providers and stakeholders to be a pressing industry issue, recently released federal data contradicts PHI's assertions that care quality among nursing homes is decreasing.