Central to any good job is the opportunity to learn, grow, and develop one’s skill set. Unfortunately, in America’s nursing homes, too many jobs aren’t good jobs; they offer poverty-level wages, inadequate benefits, and little opportunity for advancement. Attracting and retaining quality workers to nursing homes requires improving entry-level positions, but also providing meaningful opportunities to graduate to advanced roles, with enhanced responsibility and higher wages. Unfortunately, in the vast majority of nursing homes, those opportunities simply aren’t there.
PHI’s new report, Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs, argues that better nursing home jobs will improve the quality of care. Though better pay is essential for attracting workers to these jobs, the paper argues that training and advancement are the keys to retention. Nursing assistants often start their jobs with only 75 hours of training, and find they are simply unprepared to meet the complex physical and emotional needs of those they care for. Many leave within the first six months of employment, because they don’t have the training and support they need to feel confident and successful. Annual turnover of frontline nursing home workers is over 50 percent.
For those who stay—and make resident care their career–it is frustrating and disempowering to have no opportunities for advancement. You can be the most dedicated and committed caregiver, and yet never see a path to better pay or more responsibility. Becoming a nurse is not always feasible or necessarily attractive to those who thrive on providing direct care.
One way to improve jobs would be to introduce career ladders and advancement tracks for nursing assistants. Nursing assistants could specialize in dementia care or rehabilitation, or advance to mentoring and leadership roles. Isabella Geriatric Center in New York City, for example, provides three career paths: rehabilitation aide, patient care technician, and clerical support worker. These career opportunities have reduced turnover significantly, and contribute to Isabella’s reputation for providing high-quality care.
Though Medicare does not cover long-term nursing home care, Medicare does pay for seniors to recover from injuries, illnesses, or surgeries in skilled nursing facilities and rehabilitation hospitals, which are also staffed by nursing assistants. With meaningful career ladders in place, nursing assistants could specialize in rehabilitation, becoming more skilled in supporting patients who will transition home. Better support for transitions is also key to reducing hospital readmissions and the overall cost of health care.
As Raise the Floor argues, maximizing the value of nursing assistants’ knowledge and skill sets is essential to providing high-quality care in our nation’s nursing homes. We can accomplish this goal with targeted career advancement opportunities that will help to build a stable, experienced, and compassionate workforce, prepared to meet the needs of long-term residents and short-term patients.