Story Photos
 Photo by Bill Wagner Certified Nurse's Assistant Tracy Wilson checks Ovaleen Karjola's pulse Wednesday at Longview's Evergreen Americana Health and Rehabilitation Center. It's one of the many duties CNAs carry out each day. |
Nursing home industry struggling to retain quality CNAs
Sunday, April 15, 2007 12:11 AM PDT
By Barbara LaBoe
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E-mail this articleTracy Wilson's work is never done.
A Certified Nurse's Assistant at Longview's Evergreen Americana Health and Rehabilitation Center, the 37-year-old is always moving. One minute Wednesday morning she was helping a resident put on socks. The next she was getting someone else a morning snack. And a few minutes later she was helping a third resident change his soiled clothes while also soothing the man's discomfort.
"We can't dance right now," Wilson told the man, who was shuffling his feet back and forth and holding out his arms. "Maybe later."
It's hectic, but Wilson says it's typical for a nursing home CNA. She's been at it for seven years, but most CNAs barely last two, according to state industry officials. They say the hard, challenging work and low pay conspire against keeping CNAs for long -- especially when they can find less-demanding work for higher pay.
CNAs in Washington earn an average salary of $11.47 an hour, though beginners at nursing homes earn less than $8, or about a dollar more than minimum wage. The nursing home industry blames poor CNA pay partly on the state's low Medicaid reimbursement rate, which is so low that they're losing an average of $23 daily on each state-funded patient.
Despite intense lobbying, the nursing home industry expects the Legislature to fund only about half of its $60 million Medicaid reimbursement increase.
Industry officials said that's bad news for their facilities, their CNAs and, ultimately, the half of all Washington nursing home patients who are covered by Medicaid.
"It's hard work," said Dale Patterson, vice president and chief financial officer of Evergreen Healthcare Management. "And on a relative scale (employees say) 'I can flip hamburgers for the same pay or I can take care of old people with incontinence problems.' ... So of course turnover is high."
Rewarding job, low pay
Wilson's shift starts at 7 a.m. when she and two other CNAs and one Licensed Practical Nurse wake and dress the 20 residents in Evergreen Americana's Special Needs Unit for dementia patients.
Wilson said she loves the connections she makes with her patients. But the work is also messy, repetitive and physically and emotionally draining.
CNAs change adult diapers. They clean soiled beds and chairs. They help residents shower and brush their hair. They clean and insert dentures. They fend off physical attacks when residents get scared and combative. They check vital signs and chart what patients eat and drink. And they soothe the confused and lonely as best as they can.
On Wednesday, for example, Wilson stopped to talk to one resident several times as he repeatedly called out for long-dead relatives he thought were in the room.
"They're not here right now, but I am," she told him each time she passed.
"It gets hard," she said as she moved away from him. "People here don't understand or they want to leave and we have to tell them they can't. It's sad."
A 2006 Northwest Federation of Community Organizations study found that these one-on-one types of daily care are what suffer if a facility has a high number of Medicaid patients.
(The federation is made up of social service groups in Washington, Oregon, Idaho and Montana. Its study was distributed by nursing home advocates as part of their lobbying effort for more state money.)
Washington nursing homes with the highest number of Medicaid patients -- those who "lose" money for a facility -- spent an average of 44 fewer minutes on direct care of patients each day. Facilities with higher numbers of Medicaid patients also had more patients spending most of their day in bed and a greater percentage of patients with pressure sores, according to the study.
Wilson said there are times she's run ragged, but the really tough part of the job is watching patients decline and die.
"It's hard, really hard," she said. "But I like being able to help these people who need help and being able to spend time with them. They're special people."
"There's not a lot of downtime, but it's probably one of the most rewarding jobs there is," said Chris Bjornberg, director of Evergreen Americana and a former CNA. "You can say 'I've actually made someone's life better today,' and you can't do that working at McDonald's or even working at Microsoft."
Robbing Peter to pay Paul
Evergreen raised its Longview CNA salaries in March to keep up with market conditions and to be able to fill positions -- but officials said they still need help from the state.
At Evergreen Americana, for example, Bjornberg said the pre-raise turnover rate was close to 170 percent a year. (Positions being filled repeatedly contribute to the more than 100 percent number).
A facility-wide study also listed low CNA pay and high turnover as the top concern among all workers, he said.
Someone fresh out of the six-week CNA class now will start at $8.75 an hour, increasing to $10 an hour after they've received their certification and worked three months. Within a year, they'll be making up to $11 an hour. Before the change CNAs started at minimum wage and the high end of the scale was $8.75 an hour.
The move has thrilled employees but was only possible because Evergreen's Frontier Rehabilitation and Extended Care Facility has a higher percentage of insurance and Medicare patients who pay higher fees.
"So, unfortunately, we're doing a bit of robbing Peter to pay Paul because we don't have any choice," Patterson said.
Costs can only be shared so much. Last year, Evergreen shut down it's Manor facility in Longview -- which had 75 percent Medicaid patients -- because it was losing too much money. Statewide, more than 40 nursing homes have closed in the past five years at least partly due to low reimbursement rates, according to the health care association.
Previous state reimbursement increases -- most about 2.6 percent -- also helped Evergreen afford the raises. But Patterson said they weren't enough to even keep pace with true operating cost increases.
Wilson makes above the starting salary because of her experience and seniority but declined to name the exact figure. Still, she said she made more when working as a bartender.
"It's weird to make so much money as a bartender and then a place like this, where people actually need your help, you don't," she said.
Charlee White trained to be a CNA while still in high school and started as soon as she turned 18. She's been at the job for nearly three years. Originally, she saw it as the first step toward a nursing career. Now, she's thinking of finding something else.
She doesn't mind the dirty work -- "that's what I do, I'm a changer, so why would I complain about it?" -- but she eventually wants a job with more money and less stress.
"I want something that makes money," White said. "Something that I can live with."
Funding kids or funding seniors?
Realistically, industry officials know at this point they're not getting the $60 million they requested from the state.
They're happy the Legislature at least doubled the governor's $15 million request. However, they say they already had compromised with the $60 million figure because the real need is closer to $75 million.
"It's hard to get a ($30 million) rate increase and feel like a failure, but when you only got half of what you're looking for and that was still only 75 to 80 percent of what the true need is then you begin to feel shorted," Patterson said.
State officials, though, said there's only so much money to go around and point to the money they are allocating for Medicaid reimbursements.
"Nothing is ever funded at the level advocates wanted," said Anne Martens, communication director for the state Office of Financial Management, which helped develop the governor's budget. "It's a tough job to prioritize the budget and what we did with health care services was look towards children.
"We respect there is a need in nursing homes," and that's reflected in last year's $10 million increase and the current budget request, Martens added.
But that doesn't mean nursing home advocates are satisfied.
They'll be back next session -- especially because they say the need will just continue to grow.
Washington's senior and elderly populations are expected to grow at rates higher than the national average during the next 13 years, according to the Washington Health Care Association. Of those ages 75 to 84, the state increase is projected at 45.8 percent compared to 25.5 percent nationwide.
"We'll continue to limp along with less than the state paying its fair share," Patterson said. "But there's only so many Peters to rob to cover the Pauls that are short ... so we'll go back to the well again."
"I don't want them taking money for schools or anything," added Bjornberg, of Evergreen Americana. "But we pay money for health care for people who aren't even citizens and yet we can't take care of our seniors that have contributed so much to society and done so much for our country. It isn't right."
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