Nursing Assistants: We Need to Raise the Floor

REPORT: Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs (April 2016)

This report examines the need to improve America's 650,000 certified nursing assistant jobs.

These jobs--characterized by low pay, poor benefits, erratic scheduling, and little advancement opportunity--are directly linked to the quality of nursing home care.


Nursing Assistants Earn Near Poverty Wages

Nursing assistants earn a median hourly wage of $11.51, meaning half of the workforce, literally hundreds of thousands of nursing assistants, earn less than this hourly wage. One in three relies on public benefits to supplement their earnings to help support their family.

Despite the high demand for nursing assistants and the crucial role they play in resident care, nursing assistant “real” wages, adjusted for inflation, have decreased by 7 percent over the last decade.

Demographic Changes are Increasing the Demand for Nursing Home Care

As the large generation of baby boomers enters their retirement years, there will be significant growth in the demand for long-term services and supports.

The largest growth will be among the over-85 population, those most likely to suffer from diseases such as Alzheimer’s and most in need of nursing home care. Over three decades, this population will grow from 6.3 million to 18 million.

At the same time that the number of elders is growing, the number of adults in the “caregiving generations” is not keeping pace.

Low Pay and Poor Quality Jobs Are Creating a Care Crisis

As a result of low pay, as well as insufficient staffing levels, inadequate training, and limited on-the-job support, nursing home employers can neither recruit nor retain qualified nursing assistants. Not only is turnover extremely high— more than 50 percent of the workforce turns over annually—but it is becoming increasingly difficult to fill vacant positions.

Nursing homes must begin to invest in their workers today, to end the cycle of turnover and improve care—but also to ensure that they are positioned to meet future demand for safe, 24-hour care.

The key to delivering quality person-centered services is a skilled, committed direct-care workforce.

We Must Invest in America's Nursing Assistants

It is time to “raise the floor” for nursing assistants. Growing and stabilizing the workforce requires paying competitive wages, while also providing health coverage and consistent shifts with full-time hours. Additionally, to stem the cycle of turnover, workers need better training, support, and opportunities for professional growth.

Nursing homes are dependent on public funds— both Medicaid and Medicare—which provide more than half of nursing home revenues. Therefore, better jobs necessitate both public and private investment.

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