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By February 28, 2017Longevity

Everyone who cares, or needs care, should care deeply about this injustice.

To the point: Patient care providers, the actual frontline personnel in assisted living communities and skilled nursing centers, are being exploited. Their job responsibilities cover everything from ensuring patient safety and assisting with activities of daily living; to attending to such intimacies as calming despair and changing adult diapers. For this challenging, compassionate and trustful work, care providers or nurse assistants (or certified nurse assistants, a common job classification) are rewarded with average salaries of $9-13 per hour, barely above minimum wage.

Aging services operations have historically high turnover rates, attributed to the prevalence of low paying jobs. Estimates for staff turnover for certified nurse assistants, for example, average 42 percent, according to an instructive article in McKnight’s Long-term Care News (3-31-14) by human resources professional David Peasall.

Staff turnover is costly, beyond the obvious employee training expenses. HR professionals identify a number of indirect costs such as lost productivity; lesser quality of care by untrained replacements; disrupted continuity of care; lost client relationships and revenues; deterioration of employee morale; even increases in on-the-job injuries due to inadequate staffing and poorly trained staff.

Lower wage earners are known to switch jobs for as little as 15 cents per hour ($26 per month), which makes a difference to workers living paycheck to paycheck.

However, as Peasall notes, “frontline workers, wherever they are on the pay scale, are the face and heart of the organization, developing and maintaining the relationships that contribute so heavily to resident and family satisfaction.”


The problem and the solution to this injustice are two sides of the same coin. Resident and patient care staff in assisted living and skilled nursing warrant higher compensation. Until this occurs, high turnover rates will continue, as will the deleterious effects on the frontline and bottom line of the aging services providers.

But, speaking of coinage, here’s the rub. The chief executives of major aging services corporations, including the nonprofit organizations, collect high six-figure annual salaries. In fact, some rake in upwards of $1 million in compensation and bonuses, according to, the largest online source of information on nonprofit organizations.

As is and will always be the case, employees at the bottom of the pay scale argue they deserve more; while those at the top argue they deserve what they get. Guess who wins. Yet, it doesn’t take a CFO to do the math on how to more efficiently and justly redistribute salaries.

If you or a family member is planning a move to assisted living or skilled nursing, it would be worth asking about frontline caregiver turnover rates and pay. And then compare CEO compensation on Guidestar. If something smells, move on. Most likely, there are more caring providers down the street.

Illustration by Mike Luckovich, Atlanta Journal-Constitution


  • Lucy Fisher says:

    You’re absolutely correct about the challenging work of nursing assistants, their low wages, high-turnover rates and consequences of these conditions. However, many (most?) skilled nursing homes are owned by for-profit corporations. While Guidestar may be useful for non-profits organizations, families can look at’s Nursing Home Compare to see ratings of homes that receive funding from the federal government.

  • Matt Perry says:

    If I was in assisted living and you gave me the choice between having a well-paid CEO at the helm with sparkling facilities and a great marketing department… or a well-paid, well-trained caregivers who values empathy and compassion, it would be a tough call, but I’d probably choose the the latter.

  • Gary says:

    It is so sad that our most precious citizens are so poorly cared for.

  • jack says:

    If I had to tell you why I’m a Democrat, it would come down to 4 words–children and the elderly. Our young need education and healthcare and our elderly need compassionate care. Our pay scales are the truth in how much we care about something in the US. I’ve always been worried about my soul, but more than ever these days. Keep this in the news Stu–everybody needs a reality check periodically. thanks Jack

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