We need to examine the value of our long term care system within an ethical framework.
Aging Services providers are screaming from the mountain tops about the workforce crisis- is anyone listening? The workforce crisis is about the inability of aging services providers to fill open positions and the lack of competitive wages, primarily for certified nursing assistants.
How do we square the high level of quality care that most seem to desire for our frail elders with the lack of attention that this issue receives at the national level?
Other industries are also fighting for service workers. This Washington Post article reports that a Chick-fil-A owner in California is planning to pay $18.00 for front line workers. The problem is, nursing assistants in C.A. make, on average, $17.00/hr with the low end at $15.53, according to salary.com.
The mean hourly wage for a C.N.A. nationally is $14.22, and working in a nursing home or assisted living drops it to $13.73. Given these points, can we, and should we do better than this?
It is simply unrealistic to expect that we can nationally build and maintain an eldercare workforce and not address wages. For this reason, this crisis is worthy of an ethical and philosophical national discussion.
The Value of Excellence in ElderCare
Healthcare reimbursement should reflect the value that our society ascribes to quality eldercare services. To that end, we need a reimbursement methodology that invests in improving wages for front line caregiving.
Chick-fil-A can raise prices to offset higher wages. However, with less than 30% of long-term care consumers paying privately, there is no way for providers to raise pricing enough to offset higher wages. Furthermore, it is not right to balance this problem on the backs of those paying privately. Therefore, with 70% of reimbursements to skilled nursing providers coming from Medicaid/Medicare, the solution largely rests with policy-makers.
We have to seriously discuss the value of quality ElderCare in the United States. Given that a majority of the U.S. Congress being of the baby boom generation, the time is right. With this in mind, the ethical and philosophical questions to examine include:
- Does our system act in such a way to produce a greater amount of good over harm?
- Do we maximize utility- the sum of the benefits produced minus the costs (disbenefits)?
- Do we have a system that we all want for ourselves?
- Fidelity- have we kept our promise, and are we forsaking the well-being of our elders?
- Have we assigned an appropriate societal value to the work provided by personal caregivers?
Is this the right place to start?
Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare, Julie provides training and educational programs on elder caregiving for family and professional caregivers. In addition, she is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.