top of page
  • Sophia Casale

Actions Nursing Home Administrators Can Take To Retain Their CNAs Who Go Above & Beyond

As we at Gray Panthers NYC prepare to announce our Above & Beyond award winners, we thought it would be fitting to share an excerpt from GPNYC intern Sophia Casale’s master’s capstone project because she, too, strove to honor dedicated long-term care workers.

I wanted to highlight what nursing home administrators (NHAs) can do to keep their direct care staff, particularly certified nursing assistants (CNAs). These individuals provide the very care that long-term care facilities are built upon. However, nursing homes, as well as this long-term care sector as a whole struggle to keep CNAs inside a facility’s walls and the fictional confines of the direct care workforce. Systemic changes are needed to rectify this shortage of direct care workers. While Gray Panthers, our partners, and other advocacy organizations work tirelessly to make such a large-scale transformation a reality, nursing home administrators can take immediate actions to prevent their staff of CNAs from leaving. The below excerpt is meant to bring your attention to the challenges many CNAs working in nursing homes face each and every day. I hope by reading just a short portion of my capstone you can see how exceptional those working in long-term care are and why they should always be given credit where credit is due for their hard work.


Turnover rates, otherwise known as the percentage of individuals leaving a workplace or the workforce altogether, are alarmingly high in the nursing home sector of long-term care (AAHSA Talent Cabinet, 2010; Campbell, et al., 2021; Castle, 2005; Castle, Engberg & Anderson, 2007; Donoghue, 2010; Karantzas, et al., 2012; PHI, 2022; The National Consumer Voice for Quality Long-Term Care, 2022a). Nearly half of all U.S. nursing homes must replace half of their entire nursing staff each year (The National Consumer Voice for Quality Long-Term Care, 2022a). While this workplace turnover rate statistic might seem striking, the turnover rate amongst different groups of employees is even more concerning. For instance, the national average workplace turnover rate for direct care workers, namely certified nursing assistants, is close to 100% (PHI, 2022). This means that any given nursing home across America could very well be replacing their entire direct care staff annually.

A major reason for high turnover rates are poor CNA working conditions. First, the pay is low: direct care workers in nursing homes are barely paid a living wage (Campbell, et al., 2021; Stone & Bryant, n.d.). In 2022, the average hourly pay for a CNA was $12.00 (Campbell, et al, 2021). In contrast, the national livable standard for a single adult without children at that time was roughly $17.30 (Massachusetts Institute of Technology, 2023).

Second, the job is challenging, CNAs provide care using limited resources to high-needs individuals (Long Term Care Community Coalition, 2023; Travers, et al., 2022).

Third, direct care workers lack much-needed personal benefits which allow them flexibility and time to recoup from these difficult job demands (Campbell, et al., 2021; PHI, 2022; Stone & Bryant, n.d). Fourth, they are often stuck in their current position because career advancement opportunities are rare (AAHSA Talent Cabinet, 2010; Campbell, et al, 2021; The National Consumer Voice for Quality Long-Term Care, 2022b; Mittal, Rosen & Leana, 2009; Scales, 2022; Stone & Bryant, n.d.).

The most unbelievable reality of all is that direct care workers are seldom considered valuable members of a care team (AAHSA Talent Cabinet, 2010; Han, K., et al, 2014; Karantzas, et al., 2012; Kennedy, et al, 2021; Probst, Baek & Laditka, 2020; Scales, 2020; Stone & Bryant, n.d; Travers, et al., 2020; Travers, et al., 2022). However, these employees spend the greatest amount of time providing quite intimate care tasks to residents and subsequently have the most impact on the quality of care that individuals receive (Long Term Care Community Coalition, 2023; The National Consumer Voice for Quality Long Term Care, 2023).

Recent events, specifically the COVID-19 pandemic, have highlighted the difficulty of direct care jobs while simultaneously contributing to an already high workplace turnover rate (Campbell, et al, 2021; Reinhardt, et al., 2023; Scales, 2020; The National Consumer Voice for Quality Long-Term Care, 2022b). Ten years prior to 2020, nursing homes on average saw 65.6% of their direct care staff leave (AAHSA Talent Cabinet, 2010). This statistic is a far cry from the approximate 100% workplace turnover rate PHI found in 2022 (PHI, 2022). Amidst the pandemic, the subpar bare minimum job aspects of direct care, fear of contracting the virus and numerous industries competing with one another for employees impacted not only direct care workplace turnover rates but workforce turnover as well (Campbell, et al, 2021; Reinhardt, et al., 2023; Scales, 2020; The National Consumer Voice for Quality Long-Term Care, 2022a).

If action is not taken soon, the direct care workforce will continue to shrink, nursing homes will increasingly struggle to keep or find staff, and residents will receive poorer quality of care (Campbell, et al, 2021; Scales, 2020; Scales, 2022; The National Consumer Voice for Quality Long-Term Care, 2022a). As the number of older adults, who are the primary consumers of care in nursing homes, doubles from 15% of the total U.S. population in 2015 to 30% by 2060 (Kaiser Family Foundation, 2017), the reduction of direct care workers both in the workplace and workforce will create a foreboding trend. Some factors contributing to direct care workplace turnover are out of a nursing home administrator’s control. Despite this, they do have the ability to make their facility an attractive place to work (AAHSA Talent Cabinet, 2010; Centers for Medicare and Medicaid Services, 2019; Cummings, et al., 2009; Dill, Morgan & Marshall, 2012; Han, K., et al, 2014; Stone, et al. 2002). Which begs the question, what strategies can nursing home administrators implement to mitigate high CNA workplace turnover rates, and what positive effects come out of reduced turnover?


For those of you interested in finding out the answer to my thesis, I encourage you to read (or at least skim) my capstone paper. Unfortunately, these strategies and positive outcomes are far too complex for a blog post. Though I hope my excerpt piqued your interest and you find what I researched insightful in some way. The PDF below contains my completed capstone and the subsequent sources used in this excerpt. Thank you for reading and showing long-term care workers your support!


bottom of page