What The Health
Why are we tiptoeing around the obvious?
I am in no way affiliated with The Long Term Care Community Coalition. They are just what their name sounds like and they are based in New York State. At first glance of their website I am not seeing anything controversial or polarizing about the org, so I shall proceed with the link: NY state has proposed cutting training hours for Certified Nurse's Aides.
When I was 19, I was hired to take that course through a local nursing home (as they were called then). It was 120 hours of clinical work and classroom learning, and the woman who taught the course was what we might have called a battle axe back in the day— iron clad, sharp, and impactful. Her very name implied practicality: Peg. Those that did not align with Peg’s philosophy of dignified care quit the job after a week. There were three of us left from the eight that started on testing day. Of the 120 hours, the last 20 were added by the nursing home as a condition for full time employment. (I was a blossoming mess of a human being and couldn’t afford a ticket to Alaska to work on a fishing boat, so there I was. It was the job that was available to me.)
I thought of myself as decent and as possessing rudimentary compassion. I provided dignified care, and the experience shaped the adult I eventually became, while paying a living wage that supported me, my one bedroom apartment, and my cat.
I don’t know why some can subjugate themselves temporarily to lift someone else. It is true that not everyone can do that. There are plenty of people who can. The problem is the pay.
At the time, I think I maxed out at something like $8.00 an hour. Today that would be equivalent to $18.09 an hour, which I know for fact works out to be slightly more than the current starting wage of most entry level caregiving jobs. That’s $37,627 a year in today’s money before taxes. Maybe you could now sustain life on that low salary if you have a roommate, don’t require transportation, don’t have debts, and maybe qualify for HEAP and SNAP. Maybe, but probably not.
I certainly didn’t have the time or energy at the end of the day to advance my life in any meaningful way. I did not have the executive function left to push myself to go back to college at the time. I could barely muster the gumption to do a load of laundry. Exhausted, I journaled, darkly, and pined for miracle lottery win. Caregiving is backbreaking and thankless. Nobody is going to argue that it is unimportant work, either.
It is not that New York State wishes to cut the hours (by 25, for a total of 75) required to study before becoming certified as an aide, the proposal cooked up to address the hiring problem in long term care. I actually argue for the proposal: the curriculum could be condensed and care would not suffer. So much is learned on the job. However, the training is wholly not the point.
Many who accept caregiving jobs, as my later experience as a hiring administrator proved, are not the class valedictorian, typically. They’re figuring out life through their own grit. They’re desperate, like I was. Most believe they can take on the aide work temporarily, until something better comes along. When you are desperate, you likely have poverty problems like unreliable transportation, domestic violence, and addiction. These are complicated, distracting conditions that impact employee attendance, attitude, and performance.
The solution to an invested workforce is to pay them more. There’s reams of evidence-based proof that this is what fixes staffing problems. It is not a hiring problem. It is a retention problem. The 25 lost training hours are moot if the person is ethical, mildly curious, and has rudimentary compassion. Screen them for these things, and PAY THEM. Exalt them! Why not?
Why, also, are we pretending that the issue is the training when it clearly is the LTC industry? Private equity, gargantuan franchises, big boss bonuses, with the bottom line always being cost reduction instead of enhancing care. It’s disgusting. New York State needs to hold accountable and regulate in that area of the issue. If a LTC home does not pay the aides a wage that elevates and sustains them, then NY needs to fine them and divvy that money up in the form of caregiver tax breaks, free education (say from CNA to LPN), and other subsidies, if not cash.
It is a complicated problem, but the solution is simple. PAY THEM.