Alarming nursing home crisis
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Centers can't fill taxing, underpaid CNA jobs with qualified help to care for the sick and elderly.
By Cynthia Hubert
SCRIPPS-MCCLATCHY NEWS SERVICESACRAMENTO - Jackie Dunne just might have the toughest $7-an-hour job in California.
On the morning after Thanksgiving, Dunne began her work day at 6 a.m. at Somerset Nursing Center in Sacramento. She had 11 elderly and disabled people counting on her to keep them clean, fed, comfortable and content.
Before her shift ended, she would walk the equivalent of several miles and help lift residents who outweigh her. She would empty bedpans and wipe bodies. She would prepare herself at every turn for the possibility of getting cursed, slapped or zapped with a flying food tray or water pitcher courtesy of an angry or unstable resident. She would do it all cheerfully.
"It is very difficult work. It's sensitive work. It's physically and emotionally draining," said William Hunt, Somerset's administrator.
And it is work that fewer and fewer people are willing to do in a booming economy that offers so many other options for entry level workers.
California and the rest of the country are dealing with a critical shortage of caregivers like Dunne, a certified nurse assistant.
"It's the most important job in the health facility, without question," said Kristina Smith, chief of aide and technician certification for the state Department of Health Services. And it has never been in bigger demand.
These specialists, who need 150 hours of training but not a high school diploma to qualify for caring for society's most vulnerable people, are eschewing the field for better paying jobs in warehouses, retail stores and even fast food restaurants.
The situation has left nursing homes in a bind. They contend they cannot afford to pay CNAs more because of stagnant government reimbursement rates and low profit margins.
"I have worked my entire life to provide care for the most needy in our society, and I have never seen a staffing crisis as severe as this," said Judith Ryan, a registered nurse and president of the American Health Care Association.
Ryan and others fear that good care could be a casualty.
Staffing shortages translate into longer working hours, shorter tempers and less individual attention to patients, industry observers said. Such circumstances can lead to abuse and neglect, marginal care and even closure of homes.
"In this economy, all industries are struggling to fill jobs," said Debby Friedman, administrator of Saylor Lane Convalescent Hospital in east Sacramento. "The difference here is that this type of shortage can affect human lives."
At Somerset, Dunne moved at a whirlwind pace from the moment she arrived at work on Friday morning. She had no time for casual conversations with co-workers, leisurely coffee break or scanning the newspaper. "I have people depending on me," she said matter-of-factly.
She helped get residents out of bed and dressed. She fed, weighed and showered patients. She changed linens, combed hair and brushed teeth. Lifted people into wheelchairs and helped residents to the bathroom. Gently turned the bodies of patients who were confined to their beds.
Wearing a back-support belt around her waist, Dunne answered constant requests for assistance as she moved tornado-like through the hallways, greeting residents by name.
"I guess it would be easier to work at a Jack-in-the-Box," she shrugged, adjusting the foot rests on one woman's wheelchair. "But I'd rather be giving love to people. These people need someone to love them."
The industry could use a lot more people like Dunne, said Betsy Hite of the California Association of Health Facilities.
Hite said nursing homes in the state would have to recruit, train and hire about 30,000 new CNAs by the first of the year to meet staffing needs.
While nursing homes and CNAs are often criticized for poor care, neglect and even abuse of residents, a larger issue has been all but ignored, Hite said. Nursing homes, which are tending to sicker and older patients than ever before, are chronically underfunded by both the state and federal government, she said.
California nursing homes receive $90 per patient per day to care for residents who qualify for Medi-Cal, the state's insurance program for the poor. The actual cost of caring for those patients is about $120 per day, said Hite. Medicare, the federal health insurance plan for the elderly, also "significantly" underpays nursing homes, she said.
The result has been a rash of bankruptcies. Six of Sacramento's 36 nursing homes, are 109 facilities statewide, have filed for Chapter 11 protection in recent months, according to the association's figures.
"So when people ask us why we don't pay CNAs more, my answer is "Where is the money going to come from?" said Hite.
CNAs earn an average of $7 an hour in California, and even veterans rarely earn more than $9 per hour. The turnover rate among CNAs was a stunning 93 percent in 1997, figures show.
Nursing homes in Sacramento and elsewhere are going to unprecedented lengths to lure and keep CNAs. Some are offering "signing bonuses" to new recruits, and trips to Hawaii for aides who remain on the job for six months or more.
"We offer $25 in cash just to get someone through the door to fill out an application," said Friedman. "Before, you could afford to be picky. Now we look at everyone, and I mean everyone."
Some nursing homes have had to hire registered nurses, at $15 per hour, to fill CNA slots in emergencies. A few homes around the state have been forced to shut down wings because they were unable to staff them, said Hite.
This was published in the C section of the San Francisco Sunday Examiner and Chronicle, Sunday, December 5, 1999.