Workforce Issues in Long-Term Care

The National Center for Health Statistics estimated that in 1998, approximately 1,434,000 full-time-equivalent employees (FTEs) worked in nursing homes. Of this number, around 950,000 FTEs were nursing staff: RNs, LPNs, and CNAs. CNAs make up nearly two-thirds of staff who provide nursing services, while RNs account for just 15 percent. This is illustrated as well by the staff-to-bed ratio in nursing homes. CNAs have a staff-to-bed ration of 33.9 per 100 beds, followed by LPNs (10.6) and RNs (7.8). Thus, the world of nursing home care is heavily dominated by paraprofessionals. In home health care, there are approximately 368,000 HHAs.

The need for additional paraprofessional workers in long-term care will increase dramatically by 2010. Among nursing assistants, a 23.8 percent increase is anticipated by 2008, and for home health aides, the growth is expected to be fully 74.5 percent (Bureau of Labor Statistics, ‘‘Health Services’’).

Work as a CNA or HHA at the entry level usually does not require a high school education. CNAs must undergo at least seventy-five hours of training (some states have a higher minimum). The training program typically covers basics of geriatric care, such as nutrition, infection control, and body mechanics, as well as the techniques of personal care. Within four months of employment, the nursing assistant must pass a certification examination. Training for HHAs varies from state to state. For those who work in agencies that receive Medicare funding, a competency test is mandated that covers various areas of resident care. Federal law also suggests a seventy-five-hour training program for HHAs.