15% of Skilled Nursing Assistants Live in Poverty Amid Stagnant Wages

Skilled nursing and seniors housing executives have blamed wage pressures in part for their struggles in recent years, but a new analysis finds that nursing assistants haven’t seen their wages increase in a decade.

The median nursing assistant brought in $12.78 per hour in 2007, compared to an inflation-adjusted $12.84 a full 10 years later, according to a study released Tuesday by the Paraprofessional Healthcare Institute (PHI).

“This means that while goods and services increased in price, the purchasing power of nursing assistant wages did not meaningfully increase in the past decade,” PHI policy research associate Stephen Campbell wrote in his analysis.

The Bronx, N.Y.-based organization’s annual dive into the nursing assistant workforce also found that 15% live below the federal poverty line; among the general working-age population, that number sits at 7%. In addition, 37% of all nursing assistants rely on some form of public assistance, including food and nutrition programs and Medicaid.

At the same time, nursing assistants represent the largest single job title in the national nursing home workforce, with about 594,000 in 2017 — or 37% of everyone who works in the skilled nursing setting. The next-largest group, licensed practical nurses or vocational nurses, accounted for 13% at about 208,000.

They also spend the longest amount of time with residents among all job groups.

“Because of their frequent interactions with residents, nursing assistants are well-positioned to observe changes in resident condition and report these changes to licensed nursing staff,” Campbell observed.

The trends ahead for the nursing assistant segment are cloudy: With a booming economy and near-full employment in many markets, demand for the workers that typically fill the position is fierce. The majority of working nursing assistants did not attend college, and skilled nursing operators have found themselves increasingly competing against other segments that rely on workers without extensive educational backgrounds — including retail and food service.

“The poor quality of nursing assistant jobs and competition from other industries, especially when unemployment rates are low, make it difficult to fill these positions,” Campbell wrote, noting that nursing assistants are more than three times likelier to experience a workplace injury than the average American employee.

But as new payment models and consumer preferences shift more long-term care into the home, demand for nursing assistants in brick-and-mortar nursing homes will moderate, according to PHI: Through 2026, the group predicts that operators will create only 4,200 new nursing assistant jobs within SNFs.

Still, the demographic trends are hard to ignore, and those projections could shift if nursing home usage balloons as predicted. Campbell points out that the population of Americans aged 85 and older, who are likeliest to need institutional long-term care, will triple to 19 million by 2050, while the ranks of younger people who can fill demanding caregiving jobs decreases: While there are currently 32 working-age adults for every 85-and-older American, that proportion will drop to just 12 by 2050.

“Rapid growth in the population of older Americans will continue to create a need for nursing homes, even as home and community-based alternatives become available,” Campbell concluded. “Taken together, these trends make it imperative to develop strategies that strengthen and stabilize this workforce.”

Written by Alex Spanko

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Alex Spanko on Twitter
Alex Spanko
Alex covers the long-term health care industry for Aging Media Network, with a specific interest in the intersection of finance and policy. Outside of work, he reads nonfiction, experiments in the kitchen, yells at Mets games, and enjoys pretty much any type of whiskey or scotch — often all at the same time.

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