CNA Economics

[Intro: I'm a CNA & HHA with long-time hospital and private experience. My two daughters are RN's.]

The CDC came out with the results of a new survey of CNA's recently, though the actual data is a few years old. www.cdc.gov/nchs/nnhs/NursingAssistantTables.htm

Survey highlights:
- Nursing homes employed 939,000 in care jobs, of which 600,000 were CNA's.
- Average pay overall, $10.30 per hour, with an average 6 years experience.
- In that "average", non-profits and government homes paid $0.70 - $1.00 more than for-profit homes.
- 92% of CNA's were female, half were married
- 36% of CNA's had household incomes below $20,000 per year.
- 40% were dissatisfied with pay.
- 32% said management didn't do anything about poor performers.

The survey didn't ask about CNA:patient ratios (too bad).

Now for some math (credit to my grandson)
Let's say 20 patients coverage. Let's say patients are paying $3,000 a month. That's $100 per day, each. The $100 times 20 patients, that's $2,000 day income per CNA. 60% of total nursing home costs are salaries (Kindred financial statements). Of that $2,000 per CNA-day at least $1,000 is going to salaries. Of that, 24 x $10, or $240 is going to CNA's, and $760 to everyone else. CNA's are two-thirds of the staff.

At 25 patient coverage, the same $240 is still going to CNA's, and at least $1,000 to everyone else. (I'm not trying to be precise, just quick example)

Still there?

Now, who has the exposure for short staff?

Well, a lawyer who specializes in nursing home lawsuits has a blog: www.nursinghomesabuseblog.com/

What you will see is that the facilities get fined or have their Medicare status suspended. Executives don't get fired of hauled off to jail. Guess who he shows to be incompetent because they didn't notice something, or follow doctors orders on schedule. While the majority of CNA's are wonderful, the reputations of employers is not. Ask any senior) [post continue]

[post continued]
OK, so how about home care? Different, but still bad economics for the HHA/CNA in many cases. Agencies typically pay $9 to 410 per hour, but with no benefits and (thanks to Medicare policies) often short and erratic hours. Typically, the agency gives the CNA/HHA a little over half of what they are billing the client (or insurance).

Recently, they've done a good job of scaring the public into not hiring CNA's directly, and they tell clients that they'll have to use agencies under insurance (that's not usually true).

They also claim that they can provide liability insurance that CNA's don't have (not true, you can now get malpractice insurance on your own for under $100 per year. They make more claims about hiring direct that we can dispute, with facts (I go into this more in the Elder Care Notebook discussions).

For private CNA's the pressure is going to get worse. The number of agencies has doubled in 5 years, in Florida anyway. You see pitches like this from people selling agency franchises.

"Yolanda: I am currently unemployed. I am an automotive management professional..I have an entreprenurial spirit, very passionate and motivated to work hard. But now, I want to build a future for myself and my family that I can grow, nurture and build a retirment from. I have always wanted a business of my own and I agree that the elderly population is growing and a nursing home is not always the answer.

Franchiser : "Yolanda, you sound like many of our home care franchisees. In fact, we have a new franchisee here in our training class right now that was laid off from her job at Ford recently..."

Other companies selling franchises advertise: 'No medical or related experience required"

We're seeing many new agencies. These people don't want to be CNA's, actually doing the care-provider work. They want to sell CNA's services, far a big cut of the pay.

Why do people use them? They scare them. [post continued again]

They say you won't be insured, won't pay taxes like other self-employed, licensed professionals.

So, what's the problem in both situations?

Underpaid but qualified care providers are being squeezed, in both cases. And it looks like it will be getting worse, not better. As we hear the talk about "cutting health care costs" what will be cut?

The bottom line, at home or in a care facility, is care givers to care recipients. Care recipients are paying too much, and care givers are receiving too little - considering both value of services provided (ours) and value received (patient's).

so far in all this, nobodody is addressing this, as far as I've heard. Of all the participants in health care reform discussions, the actually ones on the front line - at home or elsewhere, have no voice. (certainly no lobby).

If you're with me so far, you deserve the answer from me. Well, I don't have it, but I'm not giving up. The time to get the message out is now, though, while the public is paying attention - not to mention politicians.

So....suggestions?

I wish I had a suggestion for you.

I am new to this field, my big plan was to get my CNA certification (got it) work in a nursing home for a while to get experience (doing that now) got on to a HHC agency and then branch out on my own as a provider, as I have read that a vast majority of elderly are in nursing homes only because they have no one to help them with their day to day living. (Perhaps I was misinformed on that one..)

I hope I haven't painted myself into a corner and will only be able to find work in a nursing home environment. I am not too pleased with what I have observed so far, and I am supposedly in a 'good' care facility :(

1:16 patient ratio on the Alzheimer's unit, here. Three days 'orientation' and then cut loose. At least I haven't hurt anyone, but I am only into my 3rd week and almost every day is a nightmare, mostly because I have no idea what I am doing, yet. And 3 of us on the shift are absolute beginners.

Perhaps I should have taken that retail job after all...

I do appreciate the real truth these forums offer. Glad I didn't read this before going into the field, lol

Thought about this some more, and the only solution to the problems we all seem to face in this field is unionization. The higher-ups are obviously quite pleased with the status quo (big surprise) so unionization seems to me to be the only way to have our voices heard.

Here are the links to two that I know of that cater to non industrial workers

Service employee's union

www.seiu.org/?gclid=CK33xt-o15wCFYZM5QodmEDYKw

Industrial Workers of the World

www.iww.org/

Don't let their name fool you, see what they have done for some Starbucks employees. One of the oldest unions in the world, btw.