Show us the Money!

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Donna Woodward
former CNA whose hope is to help improve the quality of life of those who live in and work in LTC homes

Donna Woodward

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!

9 comments on “Show us the Money!

  1. Jon S on

    I’m afraid that wide-spread practice of this proposed budget transparency will come only when the workers own the enterprise. I can’t wait for the day when the worker co-op (i.e., democracy at work: one worker one vote) is the way we organize our businesses, including eldercare, and truly “empower” workers.
    We can already see this in businesses like Cooperative Home Care Associates in Bronx, NY. We just need more of this: to get our public Medicaid/Medicare tax dollars moving into the control of the workers and their resident communities rather than into the hands of crony capitalists who in my experience are usually way too removed from the lived experiences of workers and residents of facilities.

    Reply
    • donna k woodward on

      Jon, sadly, I agree with you that corporate owners resist things like transparency and inclusion in decision-making. They don’t want ‘interference’ from staff, families, residents If the Bronx cooperative you mention does have budget transparency, it would be great to hear how they do this and what changes it might have brought. Maybe they could write an essay for this blog?

      Reply
  2. donna k woodward on

    Laura, thank you for giving this issue consideration. Yes, forming even a small committee that allows residents and staff the chance to become familiar with budget content and issues would be a very positive first step. Even if they only considered one line-item, e.g. utility costs and how they might reduce these, would be a good start, and I hope maybe you’re able to get this going in your organization. Thanks and good luck, Laura.

    Reply
  3. Laura Ellen Christian on

    Perhaps a first step is a staff AND resident committee that collects and coordinates budget saving/spending ideas. A different part/section of the community budget can be shared each quarter to open up ideas with the committee goal to present a betterment plan to the administrator. One step at a time! Another idea for communities is an apprenticeship or career growth program within departments that leads to a bump in pay upon completion. Supports growth for staff and tenure which could lead to lower turnover. Win, win.

    Reply
    • donna woodward on

      Thank you, Laura and I hope that as a start, you or others can make a staff-resident committee happen. Yes, maybe it’s possible to start with one line-item: “Here’s what we pay for electricity each month and here’s how we aides/staff might lower this cost.” And when ideas do lead to cost savings, pass the savings along to the staff in some meaningful way. Win, win. 🙂

      Reply
  4. Laura Ellen Christian on

    Perhaps a first step is a staff AND resident committee that collects and coordinates budget saving/spending ideas. A different part/section of the community budget can be shared each quarter to open up ideas with the committee goal to present a betterment plan to the administrator. One step at a time!

    Another idea for communities is an apprenticeship or career growth program within departments that leads to a bump in pay upon completion. Supports growth for staff and tenure which could lead to lower turnover. Win, win.

    Reply
  5. Mark Stevenson on

    As a Texas Nursing Home Administrator I try to have transparency with all things in my building. I have regular payday meetings and reward for good behavior, birthdays, and nice perks along the month. We raise money and provide school supplies and help in times of emergency, and, we look into day care discounts, and any way we can help the aides and nurses monetarily. The idea about budget transparency is a nice idea, but only in certain areas. Fixed expenses are just that “fixed” like utilities and equipment. Nursing supplies as well are contracted with national providers, as are all nursing companies across the USA. The biggest expense besides raw food and supplies is labor. Aides and nurses cannot really help in that area because experience and position always pay a certain amount. Where the raises come in is when an employee is doing a great job or has tenure as well. I instead let them know very openly the condition of their “ship” as it were. How we are doing, if we are making money and why we are not. I tell them how their care and attitude directly affect our financial success and I show them numbers, graphs and give them details.
    They appreciate this. I have seen many administrators don’t even disclose budgets to their team. I do, all the time. I ask for input during budget establishing time, around October, wants and needs. But basically, for me anyways, I do a wage analysis and go above what everyone is paying, and that has been successful and has eliminated agency, and the burden of that cost. I am very open and honest with them about their performance and what is expected, and what they expect from their leadership, and I hold all accountable. THAT, more than budget transparency has transformed my building from a fracture group to a Family working together. Is it paradise? Nope, but we constantly try and achieve a moderate outcome where residents receive good care, employees feel valued and included and that is what I do.

    Reply
    • donna woodward on

      Thank you for describing your own work in the direction of transparency, Mark. Bless you for all you do for your employees.

      “I instead let them know very openly the condition of their “ship” as it were. How we are doing, if we are making money and why we are not. I tell them how their care and attitude directly affect our financial success and I show them numbers, graphs and give them details.” This is an amazing ‘secret’ to share with your employees—that they’re central to your success! It has to be affirming for employees to have an administrator acknowledge this: that their efforts have an impact on the financial health of the organization and they’ll share in that good health (and wealth).

      A workplace might not be able to implement 100% inclusive transparency instantly. But to me it’s a principle to work toward. The ideas that aides might come up with for saving on utility costs or nursing supplies, might be surprising—and successful. PS. If one of your biggest-budgeted items is food, you’re way ahead of the game! Food quality seems to be one of the biggest areas of complaints in LTC homes.

      Reply

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