Financial, Health Challenges Faced By Nursing Assistant Workforce

A pioneering study of certified nursing assistants (CNAs) in nursing homes reveals that more than half of them incurred at least one work-related injury in the previous year. One in three received some kind of means-tested public assistance, and nearly half of those without medical insurance claimed they could not afford their employer-sponsored plan.



These statistics, gathered from the first-ever National Nursing Assistant Survey (NNAS), are presented in an article appearing in the latest issue of The Gerontologist (Vol. 49, No. 2). The lead author is Senior Policy Analyst Marie Squillace, PhD, of the Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services.



"The care of 1.5 million elderly and chronically ill persons in the United States is largely in the hands of nursing assistants - the individuals who provide eight out of every ten hours of care residents receive in nursing homes. Turnover of these direct care workers is high, which profoundly decreases the quality of life and care of the residents," Squillace said.



Many reports - most prominently the Institute of Medicine's 2008 "Retooling for an Aging America: Building the Health Care Workforce" - project there will be a shortage of CNAs in coming years. The federally-funded NNAS can be used to develop a strong evidence base for policy, practice, and research initiatives to improve nursing assistant recruitment and retention efforts.



"The NNAS is useful for improving data quality and bridging knowledge gaps. As the only national database on CNAs in nursing homes, the NNAS will improve our current understanding of a vital job," states Squillace's team of researchers. Previous studies had only examined local or regional samples that were not representative of the country as a whole.



The survey results are based on the responses of 3,017 nursing-home based CNAs. To be eligible to participate in the NNAS, a nursing assistant had to be employed by a nursing home (and not as a contract worker); be certified by the state to provide Medicare/Medicaid reimbursable service; be a speaker of English or Spanish; and be employed more than 16 hours per week.



Slightly more than half (56 percent) reported they were injured on the job at least once in the previous year. Of those who were injured, almost one quarter were unable to work for at least one day as a result.



Approximately 16 percent had no health insurance; 42 percent of that group cited cost as the reason. Years of experience did not translate into higher wages among CNAs. Those with ten or more years of experience averaged just $2 per hour more than aides who started working in the field less than one year ago. The reported median hourly wage was $10.04.



As many as 40 percent of CNAs had at some point in their lives received public benefits (e.g., food stamps, rental subsidies, or Temporary Assistance for Needy Families); almost one third were currently receiving this type of aid at the time of the survey. Additionally, the vast majority of the survey respondents (92 percent) were female.



"These and other forthcoming results will figure prominently in federal and state labor, welfare, and health policy discussions on expanding the pool of workers and on reimbursement policy, regulation policy, and program design," Squillace said. "Ultimately, this will lead to improvements in the quality of life and care of older Americans in U.S. nursing homes."