HBO documentary reveals a certified nursing assistant's struggle

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Tim Mullaney
Tim Mullaney

President Lyndon Johnson highlighted impoverished families in Appalachia when he declared a “war on poverty.” Fifty years later, as the nation takes stock of how successfully we've waged this war, the media is spotlighting certified nursing assistants in long-term care facilities as examples of the working poor.

Exhibit A is “Paycheck to Paycheck: The Life and Times of Katrina Gilbert,” an HBO documentary film that premiered last night, about a nursing home CNA struggling to make ends meet. It was produced in partnership with the Center for American Progress and The Shriver Report, which is journalist Maria Shriver's multi-platform examination of women's evolving place in U.S. society. You can watch the documentary for free online.

The Shriver Report recently published a book about the financial insecurity currently experienced by more than 42 million American women. The accompanying documentary seeks to put a human face to this statistic by focusing on Gilbert, who is a single mother of three earning $9.49 an hour at a nursing home in Chattanooga, TN.

It's easy to see why the media would choose a CNA to illustrate the plight of the country's working poor. The phrase “low-wage worker” might conjure visions of people flipping burgers or working a cash register. These are, of course, perfectly respectable jobs, but watching a short-order cook whip up a tuna melt wouldn't pack the emotional wallop of watching Gilbert care for vulnerable seniors with skill and compassion, tending to a catheter, drying the eyes of a resident weeping with loneliness, singing songs with a man in a wheelchair.

The audience can sympathize with the indignation in Gilbert's voice when she says, “$9.49 an hour for what we do.”

But the documentary is not out to vilify the nursing home for paying this wage. Neither did The New York Times lambast an assisted living facility for paying $9 an hour to aide Erika McCurdy, a single mother of two. The Times profiled McCurdy in an article that ran Sunday, “Low-Wage Workers Are Finding Poverty Harder to Escape.”

Both the documentary and the Times article focused on the CNAs to make a larger point about what poverty looks like in the United States today. It's a daunting problem driven by complex factors, including the deterioration of the domestic manufacturing sector, and job losses and labor market shifts caused by the Great Recession. The upshot is that today's low-wage workers are older and more educated than they were a generation ago, and women are disproportionately affected in many areas.

In other words, neither the documentary nor the Times presented this as a long-term care problem but rather as a national one. Yet, if the media profiles a CNA whenever the subject is low wages, that is a long-term care problem. It won't help facilities attract much-needed staff, and it won't burnish the image of nursing homes or assisted living communities among potential residents.

So what can long-term care operators do? “Not much” is the short answer, if the obvious solution simply is to raise wages. This is not feasible for many LTC providers operating on thin margins, as McKnight's Editorial Director John O'Connor wrote yesterday in his “Daily Editors' Notes” blog post.

However, the documentary on Gilbert suggests there are some steps that long-term care operators could take. One is to find ways to implement paid sick days. “Paid sick days would be a game changer,” Maria Shriver said at a press event for the documentary, referencing poll results from The Shriver Report.

Another potential step is to know what community resources are available and find ways to share this information with staff members. Gilbert is exceptionally lucky to get her children enrolled at the Chambliss Center for Children, given that daycare fees are well beyond her means. The Times article highlighted the importance of Metropolitan Ministries, where McCurdy receives help in paying an unexpectedly high utility bill after the cold winter.

No doubt spreading the word about organizations like these among staff would be a delicate matter for long-term care operators; for one thing, I'm sure no employer is eager to acknowledge that it is paying wages so low that workers might need this sort of assistance. But it also does not behoove a facility to employ a CNA who is exhausted and anxiety-ridden — and it's not always obvious when an aide is stretched nearly to the breaking point. When Gilbert's coworkers saw the documentary, they reportedly were shocked at how much she had been struggling. Gilbert responded that she “didn't show it” at work.

Finally, having a workplace culture with a strong professional development component could help. Long-term care is full of people like Lori Porter, who rose from CNA to administrator (and McKnight's contributor!). But as Porter's own story demonstrates, mentors and strong leadership are essential for CNAs to achieve this type of career (and wage) growth.

As the Times explained, it might be more difficult than ever for low-wage workers to escape poverty. But long-term care facilities don't have to be low-wage traps; more than many other employers, they can offer these workers a route to a financially secure future.

Tim Mullaney is Senior Staff Writer at McKnight's. Follow him @TimMullaneyLTC. 


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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 Marty Stempniak.