CNA Horror Stories: Caregiver Crisis in America Nursing Assistant Job from Hell

Caregiver Crisis

While nursing homes bankrupt families and drain state and federal Medicaid/Medicare coffers, they pay the people directly caring for your loved ones barely more than minimum wage.

The working conditions? Often deplorable. Erratic schedules, double shifts, no health insurance, and poor staffing levels. CNAs in hospitals face similar challenges, often dealing with emotionally and physically demanding environments.

Who would even want such a job, given the worst aspects like demanding residents, emotional toll, and frustrations with families? That’s the scary part. If the nursing assistants are not passionate about what they do (and many are), the labor market is pretty simple in the way it works: You get what you pay for.

Turnover of nursing assistants in nursing homes is outrageously high – about 50 percent annually. These are the people helping your parents to the restroom, changing diapers, transferring them from a wheelchair to a chair or bed, feeding them at meal time if they are unable to feed themselves, and providing supervision and emotional support.

Often, patients are in end-of-life situations or their minds are gone, ravaged by Alzheimer’s or other dementia-related illnesses. They are so defenseless they are unable to even report abuse if it occurs, or if they do, they aren’t taken seriously, as it is chalked up to “the dementia.”

Welcome to the latest black eye on the American elder care system. It’s a crisis that goes beyond bed sores.

Report: Mean hourly wage is $11.51

In a new report, “Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs,” the Paraprofessional Healthcare Institute ( PHI) meticulously documents some alarming facts and trends, including:

Mean (not average) hourly wage for nursing assistants is $11.51. That means half of the 650,000 strong workforce is earning less than that. Many rely on public aid to supplement their income, even though they often work overtime hours. Their wages, adjusted for inflation, have declined 7 percent in the past decade, even as demand for such workers has risen dramatically as Baby Boomers age.

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About 45 percent do not have health coverage through their employer or a labor-management health fund. Many of those who are offered health insurance cannot afford the monthly premiums, copays and deductibles. With low pay and families to feed, this creates an environment where workers may go to work sick just to make ends meet.

Ill employees in a nursing home is a public health disaster, with the nursing home population being elderly, immune compromised, and in close quarters. Rampant, bug-driven Illness in such facilities does break out occasionally, sometimes resulting in “lockdowns” and loved ones being told to “stay away” unless absolutely necessary. (By the way, those making less than nursing assistants in nursing homes include the food workers, at $9.38 per hour. You see where I’m going here).

Chronic absenteeism, exhausted workers

Absenteeism among nursing assistants often is chronic, resulting in never-ending schedule changes and the dependable or readily available employees being called in to work double shifts. Already understaffed, consider the consequences of a nursing assistant who falls asleep on the job, particularly in a memory care unit, where patients routinely wander, fall, and become injured.

Nursing assistants receive very little training and almost no professional development. Because they are essentially considered unskilled workers, they are looked upon as an expense to be managed, not career people in need of development. The sad truth is that such conditions result in the hiring of employees that can be insubordinate, rude, and unprofessional.

While corporate America may want to dismiss such accusations (70 percent of nursing facilities are operated by for-profit companies, with over half of all facilities owned by chains) anyone who has had a loved one in a nursing home knows this to be true. It is not uncommon for families to move a loved one from one facility to another out of fear of their loved one’s safety after witnessing negligence resulting from employees distracted by gossiping and fighting amongst themselves.

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“Many aides prefer their jobs to nurses’ medical and administrative roles, but the presumption that direct care is not a career devalues this work and contributes to low hourly wages,” the report explains. “Rather than building nursing assistants’ skills and loyalty – through quality training, regular schedules that provide full-time work, and living wages – nursing home executives and administrators keep the wage floor low for these positions and accept the consequences of high turnover. Unfortunately, nursing home residents and their families ultimately pay the price when constant staff turnover compromises care.”

Current situation deemed ‘untenable’

It is important to emphasize that a majority of nursing assistants do the best job they can given their substandard working conditions. But the bad apples that are hired due to the reality that it’s a job nobody wants can cause severe and inexcusable harm to our nation’s fragile, vulnerable, and often defenseless elderly.

The report calls the current situation “untenable.”

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“Increasingly, employers report that they cannot recruit sufficient numbers of qualified workers,” says Jodi M. Sturgeon, president of PHI, in a news release. “Nursing homes deliver an indispensable service, providing support to individuals who cannot live safely in their homes. Ensuring quality jobs for nursing assistants is essential to improving the quality of care in these long-term care settings.”

A workforce of well-trained, experienced caregivers is impossible to build unless caregiving jobs are more highly valued, the report argues. Nursing assistants need better wages, but also jobs that offer sufficient training, on-the-job support, and opportunities to grow, learn, and advance professionally, the report states.

“We need to see nursing assistants as important assets to quality care,” Sturgeon says, “not as an expense to be managed. Employers need to invest in training, supportive supervision, and career paths to keep experienced workers on the job.”

A call to action by PHI: Better training needed

To support that investment, PHI calls for Medicaid reimbursements to cover the true cost of labor, according to the news release. “Raise the Floor argues for increases in rates to be tied directly to wages and benefits of nursing assistants and other low-wage support staff. The paper also makes the case for updating training requirements, which have not kept up with increases in acuity and behavioral health issues among today’s nursing home residents. Alzheimer’s disease and other dementias affect half of today’s nursing home residents.”

As nursing assistant Maribel Rodriquez from Waterbury, CT, who is quoted in the news release, says of her work, “It’s hard physically, mentally, and emotionally. To be successful, you need to be prepared for what you can control, but more importantly, you need to be prepared for what you cannot control.”

This report focuses on nursing homes, and nursing homes are considered a “medical” model. Despite the outrageous conditions these employees (mostly minority women) work under, they had to go to school and become certified in order to even obtain the job. However, in assisted living and “memory care” facilities, this is not always the case, depending on the state.

Assisted living, often branded as “memory care,” is based on a social model. Many families do not understand this going in, as they are under the impression their loved one’s medical needs will be the focus of their residency in the facility. Families often are sold on the loved one being able to stay at such facilities until death with supplemental palliative and hospice care. But approval of palliative and/or hospice care is not automatic, and not all hospice organizations are created equal.

Worse, private-pay facilities are held to even lesser requirements than those receiving state or federal money and the requirements attached to it, although even those are lax and lack transparency, according to the report.

“It is important to recognize that, as a result of limited transparency, it is difficult to assess how nursing homes spend the public dollars that are their primary source of revenue,” the report states. “Most states do not require public reimbursements to be spent primarily on the provision of direct and indirect care. Without accountability mechanisms, facilities may direct these funds to administrative overhead and profits rather than appropriately compensating nursing assistants and other low-wage nursing home staff.”

The Reality of Working as a CNA Challenges in Nursing Homes

Nursing homes are grappling with a myriad of challenges that hinder their ability to provide quality care. One of the most pressing issues is staffing shortages. Many nursing homes struggle to attract and retain qualified staff, including CNAs, due to low wages, poor working conditions, and limited opportunities for career advancement. This shortage often leads to inadequate care and even neglect, as overworked staff struggle to meet the needs of all residents.

The complexity of residents’ needs is another significant challenge. Many patients require specialized care, such as wound management, medication administration, and behavioral support. Meeting these needs while adhering to stringent regulatory requirements related to patient safety, infection control, and resident rights adds another layer of difficulty.

Financial constraints further exacerbate these problems. Limited budgets often mean that nursing homes cannot invest adequately in staff training, equipment, or facility improvements. This can result in substandard care, affecting everything from nutrition and hygiene to social activities. To overcome these challenges, nursing homes must prioritize staff development, invest in technology, and foster a culture of person-centered care.

Consequences of the Caregiver Crisis

The caregiver crisis, marked by severe staffing shortages and high turnover rates, has far-reaching consequences for patients, families, and the healthcare system. One of the most immediate impacts is on patient care. When there aren’t enough caregivers, patients may experience delays in receiving essential services like medication administration, wound care, and mobility assistance. This can lead to deteriorating health conditions and increased hospitalizations.

Families are also deeply affected by the caregiver crisis. Finding reliable and trustworthy caregivers becomes a daunting task, leading to increased stress and anxiety. Many family members end up taking on caregiving responsibilities themselves, which can result in burnout and emotional exhaustion.

Economically, the caregiver crisis is a significant burden. Healthcare systems must allocate substantial resources to recruitment and retention efforts, including training programs, bonuses, and benefits. The crisis also drives up costs related to hospital readmissions and emergency department visits. To mitigate these issues, healthcare systems need to focus on workforce development, invest in technology like telehealth, and create supportive environments for caregivers.

Breaking the Cycle of Burnout

Burnout is a pervasive issue among caregivers, including CNAs, nurses, and other healthcare professionals. It often stems from chronic stress, heavy workloads, and a lack of control over work environments. To break this cycle, caregivers must prioritize self-care, incorporating stress management techniques, regular exercise, and social support into their routines.

Healthcare organizations also play a crucial role in preventing burnout. Providing regular breaks, flexible scheduling, and opportunities for professional development can make a significant difference. Creating a culture of wellness, with access to mental health resources and employee assistance programs, is equally important.

Empowering caregivers to have a say in staffing ratios, workload management, and patient assignments can also help alleviate burnout. By focusing on caregiver well-being and creating supportive work environments, healthcare organizations can reduce burnout, improve job satisfaction, and ultimately enhance patient care.