Health & Wellness

One Way to Judge a Nursing Home

From the NY Times – By Dale Russakoff – While looking at nursing homes for my mother, I always asked the tour guides if I could talk to the nurses’ aides. This seemed to me a logical request. After all, these were the women — and they were all women — who would spend the most time with my mother, who would notice small changes that raised big questions, who would make her feel cared for. Or not.

“They don’t do that,” I was told almost everywhere I visited.

I soon realized why. In casual conversations in hallways and dining rooms at more than a dozen facilities, I found only one nurses’ aide who had been on the job more than six months. I was witnessing in real life one of the most dismal statistics in long-term care: More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.

Then came the tour guide who didn’t say no. “No one has ever asked that before, but why not?” the marketing director of a New Jersey nursing home said in response to my request. He said he would ask three aides then on break if they wanted to talk to me. They said yes.

I asked how long they had worked there. One said 12 years; another, 8. The third answered: “I’m the baby. I’ve been here four years.”

I decided this was the place for my mother. These women used the word “we” when talking about the nursing home, making clear that they felt a sense of ownership. And it seemed significant that the marketing director asked their permission before allowing me to impose on their break time. Moreover, he trusted them enough to leave me alone with them in the break room.

That was 10 years ago. I do not know exactly what I would find today, but the overall situation has not changed. The reasons for the high turnover rate among nurses’ aides are the same as they were then: low wages ($10.48 an hour on average), poor benefits, high injury rates and lack of respect on the job.

What has changed is that the industry, the federal government and the states have all identified the turnover rate as a crisis in long-term care, particularly with demand poised to soar as the baby boom generation ages. Researchers have found that high turnover in a facility corresponds with poor quality of care — more bedsores and more use of restraints, catheters and mood-altering drugs. That is, more reliance on medicine and technology, less on relationships.

“Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end,” said Peggy Powell, a senior staffer at PHI, formerly known as  the Paraprofessional Healthcare Institute, a nonprofit group focused on improving the front-line work force in long-term care.

In nursing homes with high turnover rates, certified nursing assistants tend to leave within three months, often because of inadequate training and support to juggle multiple frail, ailing residents at a time, according to Robyn Stone,  senior vice president for research at the American Association of Homes and Services for the Aging. Once aides leave, everyone else must pick up their caseloads, and the stress of the job rises.

Culture change initiatives are under way in nursing homes around the country to make aides’ jobs more fulfilling — not so much through better pay, but by offering better training, more responsibility and more respect from superiors. The aides at my mother’s nursing home had all this, plus health and pension benefits.

Ericka Dickens had been there for nine years when she became my mother’s aide. She had the patience and experience to navigate my mother’s stormy moods as her dementia worsened, to notice immediately when she was feeling weak or sick. Sometimes I would arrive in the early morning to find Ms. Dickens sitting beside my mother, holding her hand and talking to her.

I hadn’t seen Ms. Dickens since shortly after my mother died six years ago. Recently I called to see if she still worked at the nursing home. I discovered that she is now in her 20th year, currently assigned to the physical therapy department. I visited her there and found her assisting a resident who looked up at her at one point and said: “Oh, Ericka, you look so good. You always look so good. You’re a good friend.”

I asked what made her want to stay in the job all these years. She said she always felt respected and supported, but the anchor for her and others is the bond with residents. (There were five other aides from my mother’s era on the afternoon shift that day, including one who had been there for 25 years.)

“We have reminiscences about this person and that person, how we used to love this one and how we used to love that one,” Ms. Dickens said. “They become your family. A few weeks ago, someone passed away, and Winnie and I went to the wake. Her daughter was so happy when she saw us, she started crying. And you feel: ‘Yes, I did something. I’m part of something.’ It’s really fulfilling.”

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter
and Download the AMAC News App

Sign Up Today Download

If You Enjoy Articles Like This - Subscribe to the AMAC Daily Newsletter!

Notify of
Oldest Most Voted
Inline Feedbacks
View all comments
10 years ago

My wife was recently in a nursing home for rehabilitation following surgery for a hip implant. The therapy was great, the care often left something to be desired especially during the “graveyard shift”.
A meeting with the Director of Nursing found the issue was known “for the past 20 years”; I immediately realized my ned to get my wife out of the facility ASAP. The explanation was tactfully explained as the aide being “task-oriented” rather than people-oriented. She was banned from my wife’s wing of the home until we left.

CC Mac
10 years ago

Thank you for this thoughtful piece on an important subject. You have identified the biggest problem (high turnover of the CNAs) and I have some thoughts on this.

Workforce specialists always identify these jobs in nursing homes as ‘high-demand’. Nursing homes are always hiring, but, ironically, the demand is created in large part by the high turnover rate due to job dissatisfaction and low wages. Nevertheless, there is always grant money earmarked for training in ‘high demand’ jobs.

There are a few gems like Ms. Dickens who are a good fit for the job and find it fulfilling. But the majority of CNAs find themselves in it because it is one of the few areas in which you can get trained quickly (about 2 weeks in my state) and often there are government programs that will pay the tuition for the training. These government programs even pay for textbooks, uniforms, shoes and the cost of taking the qualifying exam several times until the student gets a passing grade.

So the type of job-seekers attracted to this field are: 1) Welfare recipients who are being pried off the welfare rolls and aided in finding job training (Sounds good, but, let’s face it, often their heart is not in it!) 2) Recent immigrants/refugees, displaced homemakers, and high-school dropouts who desperately need an entry-level position and think they can make it on $10.48 an hour.

What is sadly missing is the applicant’s ‘calling’ to do this particular kind of work. They soon learn (in addition to the fact that work sucks and they can’t make it on their salary) that not everyone is suited for bedside nursing and that elderly incapacitated people are not cute.

The saddest aspect of this problem is that the vulnerable elderly residents are being handled by people who would rather be doing anything else. What a great idea to speak with the CNAs when choosing a home for Mom or Dad!

Would love your thoughts, please comment.x