former CNA whose hope is to help improve the quality of life of those who live in and work in LTC homes
A recent Pioneer Network Roundtable discussion about staffing in long-term care homes touched on two related issues: increasing wages as a way of retaining staff, and the value of broader input into the budget decisions made in long-term care homes. We hear a lot about the need for culture change in long-term care. “Culture change, meet budget transparency.”
When the issues of CNA staffing and wages are raised, the response is never, “Sorry, we don’t think you deserve better wages. We’re not going to pay you enough to live on if we can get you to work for peanuts.” No, Administrators will say, “Yes, we know aides are worth more and we would love to pay higher wages. We just can’t afford to. The money isn’t there.”
Are you sure about that? Show me the money. Let us see your budget. Every organization has a budget, detailing what comes in, what goes out and where it goes. Long-term-care administrators say they can’t afford innovations that might make life more comfortable for residents and aides alike. They can’t find the money to increase staffing or raise aides’ wages. Maybe so, but we aides would like to be included in the search.
If you attend conferences and webinars and read articles on how to achieve quality care in long-term-care homes, you’ll often hear the word ‘empowerment.’ Residents need to be empowered. Persons living with dementia need to be empowered. And direct-care workers need to be empowered—that’s what the experts say. What could be more empowering than having a say in how money is spent?
Including aides in a transparent discussion of resource allotment would demonstrate trust in us, respect for us, and appreciation for the creativity we might bring to problem-solving. There may not be a wealth of money being wasted or misspent. But aides are in a unique position to see opportunities for cost savings that others might overlook.
As a CNA I saw the amount of food that, at the end of every meal wasn’t in the stomachs of residents but in black plastic waste bags. I saw the wastefulness in our use of disposable items like plastic cups, paper plates and napkins. Without impacting the welfare of residents, aides might find multiple ways of cutting costs so that money might be re-directed to salaries and staff perks – or to innovative products that could improve residents’ and aides’ qualify of life. We might bring fresh vision to decision-making about saving and spending. Give us a chance!
Perhaps administrators protect budget secrecy out of embarrassment over the wide gap between the salaries of aides and the salaries of the executives and managers. Or out of worry that awareness of this gap might lead to poor morale. Maybe the organization worries about privacy rights; why should anyone’s salary be public knowledge? First of all, budget transparency doesn’t mean that individuals salaries have to be known. But if it did, would this be so bad? Americans are more open about their sexual practices than about their finances! We know the salaries of the President and members of Congress and of the CEOs of publicly-traded corporations. This is a tool of accountability. There are ways to protect information about individual salaries (as the federal government does for federal employees) while making information available about salary ranges, the percentage of the budget spent on various classes of jobs, etc. This privacy issue is a red herring, a ploy to halt discussion before it starts. It’s not a justification for saying no to budget transparency.
Employees, even aides, aren’t children. We’re capable of understanding issues, of being reasonable. We can understand that some positions merit higher wages than others and that some employees will deserve to earn more than others. We can be patient about wage increases. But we shouldn’t be shunted off to the side when budgets are discussed, as if we were just another piece of equipment in the workplace. (And neither should family members!) We need to breach this wall that seems to create a ‘them’ and an ‘us,’ the intelligent responsible people on one side and lower class workers on the other. We’re all part of the care community; we all want to improve it. One way to do this is to make budgets more transparent. If we want to retain employees and attract new job seekers, salaries and working conditions in long-term-care homes must become more appealing. I suspect that money might be found to do this, if budgets were transparent to all stakeholders: employees, family members, and residents.
Let’s hear a call for budget transparency from the leaders of the culture change movement. Show us the money!