Certified nursing assistants turnover: A nursing home crisis

Dec. 23--Wages and health insurance are steadily luring certified nursing assistants away from the five nursing homes owned by Centers in the region.

They're going to other places -- Fort Hudson Nursing Center, Wesley Health Care Center, and even retail jobs where the minimum wage next year will be higher than the starting CNA wage at the Centers.

But as they leave, residents are falling and getting injured more often. Their families say the nursing teams run "short" of staff regularly. CNAs at Glens Falls Center in Queensbury also said they are often short-staffed.

"The reality is, throughout upstate New York there simply are not enough CNAs," said Fort Hudson Nursing Center CEO Andy Cruikshank.

"Wages and benefits are part of the recruitment agenda. But there's no doubt we hire from each other," he said. "The real challenge we all have is there's not enough people."

That's pushing up wages at many nursing homes -- but not the five owned by Centers Health Care.

Centers bought the homes beginning in 2015 and is now negotiating a labor contract to cover employees at all five locations. But employees say the company "won't budge" on wages and health insurance costs. That's pushed many of them to leave.

"$12.50 for CNAs, we know we can't compete with those wages because people are leaving here to go five minutes down the road," said union organizer Melissa Tambasco, who does not work at the facility.

They're not all leaving. Some want to stay, citing the close relationships they have formed with the residents.

CNA pay disparity

The Centers: $12.50 an hour to start

Fort Hudson Nursing Center: $13.99 to start, then $14.41 after three months

Family health insurance at the Centers: $800 a month

Family health insurance at Fort Hudson: $694 a month

But it's gotten so bad that Warren Center recently started training people to be certified nursing assistants, at no cost to them. That's not a unique solution: Wesley and Fort Hudson have long been training their own employees with free CNA classes. Wesley just got a $95,000 grant for CNA training from the Governor's Economic Development Council.

While the new Warren Center students said their starting wage of $12 an hour was more than they had ever been paid before, CNAs can get paid far more just a short drive away.

At Fort Hudson Nursing Center in Fort Edward, starting pay for CNAs who have no experience is $13.99, and it goes up to $14.41 after three months. That's more than what one CNA at Glens Falls Center said she has being paid after six years.

Those with experience can start with pay as high as $19.19 an hour at Fort Hudson.

At Wesley Health Care Center in Saratoga Springs, experienced CNAs are being offered more than $15 an hour.

But what seems to be the bigger problem is the benefits.

At Centers, family health insurance premiums are more than $800 a month. That's before co-pays and deductibles for the actual health care. Centers officials declined to discuss the details of their plan or why it was so high.

At Fort Hudson, the family insurance premium is $694 a month, with a $3,000 deductible. Fort Hudson pays the first $750 of the deductible. The agency encourages workers to take the single-employee health plan, which is $64 a month with a $750 deductible after Fort Hudson's contribution.

By comparison, Centers is about $200 a month for single employees.

Health insurance plans on the state health marketplace, which offers subsidies for those who do not have health insurance offered by their company, cost an average of $75 a month for one person. But those who have a company plan available to them can't take a subsidy for the state marketplace unless they can prove that the company's cheapest one-person plan is more than 9.86 percent of the employee's entire household's income.

Fort Hudson watches the rates of its competitors closely to make sure it doesn't fall behind.

"We believe we offer a generous plan," Fort Hudson's Cruikshank said.

He noted that Fort Hudson pays 95 percent of the premium for the high-deductible single-employee plan, and then half of the deductible.

He's also worried about pressure from McDonald's and retail stores, which might offer better pay without requiring months in class for a health care certification. On Dec. 31, the hourly wage for fast-food workers will rise to $12.75, as required by state law.

"When McDonald's raises their rates, Target raises theirs. It pushes the floor way up," he said.

But he supports the increase.

"I think that's a good thing, especially for CNAs," he said. "Our rates go up every year. Some years, we bump them up twice a year. We believe in compensating our employees as aggressively as we can, because they are the most important thing we have. The better quality they are, the better experience the resident will have."

He's careful in who he hires, saying the job isn't for everyone. It involves taking care of people who may soil themselves, might be deeply upset about being so disabled that they have to be in a nursing home, and might be disoriented or otherwise difficult to care for.

Because it's so important, "we don't take everyone who walks in" asking for a job, he said.

But he wonders if the lack of CNAs is partly due to a discomfort about nursing homes.

"Let's face it. Nobody wakes up and says, 'I can't wait to live in a nursing home,' " he said. "Not because it's a bad place, but because it confirms my disability. I would challenge most anybody -- they actually have a very high quality of life here. They have a sense of community here."

But from the outside looking in, he said, potential employees might not want to work in a nursing home.

"A nursing home turns people off," he said. "It's a public perception ... that's just the world we live in."

So while he pushes for higher wages, health insurance and other benefits for the CNAs, he tells them that they should stay on the job for a different reason.

"You have a profound opportunity to make an impact with the residents," he said.

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