patient to caregiver ratios


Hi, my name is Deidre. I live and work in Ct as a CNA in homecare. I love my job but that hasnt always been the case. I use to work in LTC and moved around a lot between facilities untill I found out about homecare. I would not be a CNA today if it wasnt for homecare. I have seen a lot of abuse and neglect over the last twenty years infacilities. Some I have reported (and been thrown out once for doing so) I contacted the family before I left. Other times I would just quit. The nurses hands were tied. At times I was faced with neglecting residents myself and I knew I had to leave. There was just no way to provide quality care when the ratio was so high and the other aids were so busy with their long list that nobody could help you with lifts or transfers. It was a nightmare and I couldnt do it so I left this work for many years. Now that I have been working once again as a CNA I have in the short span of 6 months witnessed several cases of severe neglect. SO now what? Well, thats why I am writing. I am tired of the abuse and neglect going unchecked. Something needs to change. The ratio of residents to CNAs is a huge problem . I have contacted Senator Rob Kane about my concerns and what I have witnessed over the years and he , through his legal aid Kate O'Keefe , has put me in contact with Diane Smith RN from the Ct. Dept. of health. I am corresponding with her now and I am asking that if any CNAs or nurses have anything to share about this ratio problem and how it has affected you personally, I would love to hear about it and possibly share your story with Diane Smith. Something has to change. One day we could be the ones who end up in LTC and I fear by then it will be much worse. I will never forget the 92 year old lady who screamed in my ears and held on to me wth all her might cause she was afraid I would drop her on the floor. I wasnt even moving her but she had been dropped before. I knelt down on her bed till she let go of my hair and whispered reassurance to her. When she calmed down she looked in my face and said, "when I die I am putting in an order for pink fluffy wings for you." This is for you Margie. There is more that I can do about this than just offer temporary assurance. I want to see the patient to aid ratio changed. We have to speak up. You can remain anoymous if you like. I know the threat of losing your job is real and the last thing I want to do is cause any problems for health care workers. I have been learning a lot about the politics of health care and if anyone wants to give me a heads up as to why they think things are so bad I would appreciate that too . Thanks. Dee


207 Posts

Specializes in CNA. Has 5 years experience.

"...I have been learning a lot about the politics of health care and if anyone wants to give me a heads up as to why they think things are so bad I would appreciate that too....".

There is no dark conspiracy or secret. It's money. It's that simple. If there was enough money to pay CNA's good wages and to have reasonable ratios, there would be. Ratios have been often brought up in health care legislation in many states. I believe it has passed in a few states --- others on this forum may work in a state-funded institution and may be aware of ratios.

24/7 care in an institution is immensely expensive. Contrary to the beliefs of some CNA's, nursing home operators, as a whole, make very little and have to scrimp to be profitable. It's very expensive to run and maintain a building as well as pay for all the medical supplies needed.

If you come up with an idea to fund nursing homes, please let us all know. One solution is to have this all paid for in taxes similar to socialized medicine so that everyone would be able to get LTC, if needed. But, as soon as you use the phrase 'socialized medicine', there are dirty looks all around.

Has 12 years experience.

Its interesting that you believe that their is no money for better care. There are facilities that exist with lower ratios. They seem to have the money. Maybe their profit is not as high, I dont know, but seems funny to me that some ratios are low and some are high. I dont think its lack of money. I think its more like Greed. Why is it not a crime when elderly are neglected and treated like an assembly line? Can you imagine treating children like this in a daycare center? It doesnt have to be that way and it shouldnt and its wrong. I am not asking for better pay for CNAs. Its a 1 month course. The pay fits the training. But ratio is way off. 12 residents to one CNA. Higher in some places too. I saw 16 at one place in Waterbury. COme on. Thats just plain nuts. How can there be any excuse for that. I dont accept the excuses given and if more people stopped accepting them then something could change. It would have to. Thanks for your opinion. Dee


207 Posts

Specializes in CNA. Has 5 years experience.

"...They seem to have the money. Maybe their profit is not as high, I dont know, but seems funny to me that some ratios are low and some are high. I dont think its lack of money. I think its more like Greed....".

I'm really big on discussions of economics which I do on other forums focused on economic issues. Yes, I cannot generalize for every place across the country. There have been well-documented cases of nursing home operators having the 'big house, big car' kind of thing and greatly profiting off others. But, very few CNA's (appear) to understand business. I assume, #1, that you know how much just providing basic care to someone, 24/7 costs and that only a handful of people in this country can afford this on their own? Do you know many people who can afford $50,000+ a year to provide for their own care, or are insured to do this? Many CNA's do not understand all the overhead of this business: the cost of maintaining facilities and supplies that creates this $50,000+ number.

Also, I assume you realize that there are private and publicly funded LTC's, and many are mixed. That is, they take private pay patients, but have some ratio of Medicare beds that are subsidized by the government.

I'm in the 'boomer' generation. We have increasing number of people going into LTC (even though, as a whole, we're getting much healthier as we age and the actual % of people who go into LTC is low).

Do you want to write to your reps to have your taxes raised to provide better care for people more my age? Are you going to purchase LTC insurance, while you're young, so you can afford the care you want and not rely on the government?

Nothing is impossible as far as funding, but this is one problem, in a long line of problems, facing the country right now and everyone wants a stimulus and tax cut. Someone has to pay for this care.


416 Posts

I understand you're upset but like the others have said, its a complicated issue thats not going to get resolved quickly. Its going to take years of dedicated work on many levels, with the insurance companies, the actual residents,the ltcs, and the government. Right now with the economy being so bad, there are other issues that rank higher in priority like the people losing their homes,the number of people applying for foodstamps ect.

Never in my college education has anyone ever said "if you want to make real money open up your own ltc". In fact I think as things get worse like they are projected to, you're going to see some very good homes close down.

We cnas do what other health professionals do, do the best with what we have. We work in the best places we can, give 200 percent every day, and hope and pray that things don't get worse. For things to get better and ratios to be perfect is what we'd all secretly like but exp has taught us its not with our energy to focus on.

One thing to note in ratios, is the level of care required for each resident. I work on a 38 resident hall with one other person on graveyard. But most of mine are mostly independent with the exception of 10. There are nights when everyone needs me but those are few and far between. The ratio is relative to the amount of care required to the individual resident.

fuzzywuzzy, CNA

1,816 Posts

Specializes in LTC. Has 3 years experience.

Better ratios would be nice, but it wouldn't solve all abuse/neglect problems. Some people are lazy and just don't care. If they had the time, they still wouldn't bother with much. Others WOULD use the extra time to provide better care.


30 Posts

It is really sad and horrible of how other caregivers care for the elderly in resthomes. I just started work recently and I have observed couple of caregivers wipe their genitals so roughly that they clinched up their hands and feet. It so hurts my feelings to see them lying on the bed feeling helpless and that they can't have a say because no one ever listens to them anyway. Let's just pray and hope that God is watching those UNCARING caregivers and may be punished in the end.

Has 12 years experience.

I read all these responses and I thank you for taking the time to post your thoughts. You say most CNAs dont seem to understand finances ( Im assuming you are suggesting that they are uneducated) but I understand very well. My husband and I own our own home and I run a business of my own. I use the money from my business for investing and I work as a private duty CNA for spending money. Its a low stress job and allows me the energy for my own personal interests. Im not wiped out come the weekend nor do I have any stress related problems. I love my job. As a private duty CNA I am making almost what an LPN makes, I am smart. So dont worry about me not understanding finances. I can do the math. One suggestion I am making to the health department is for higher staffing at busy times. Or for a few part time aids to come in who would just do showers. Anything would help. Your wrong about the problems of abuse and neglect staying the same. I have worked in low ratio facilities and in high ratio facilities and the patient care differs in that the more stressed the CNAs are the rougher they are in patient care. Its adrenaline. You cannot work as an Aid in a facility without adrenaline if you want to be able to get your list done and not get fired. Thats the bottom line. Nobody goes into CNA work cause they want to abuse frail people. (could be a few sick exceptions) They go into it to help people and then find that unless they are fast,neglectful,cold and uncareing...they wont last. I know many CNAs and they have all talked about this because I've asked them about it. To GWAPALICIOUS... I know how it feels to have to witness what you saw. But I say we owe it to those who dont have a voice to be their voice. We could report those CNAs every day but you and I know it wont ever stop untill something changes. That is what I want to do. I have to try. I do pray that GOD sees and helps but we are GODS hands on this earth. Pray instead that he gives you the courage to try to change things. Dont pray that GOD does the work for you but that he works through you. Pray for wisdom and and discernment. People will tell you it cant be done. People will tell you that their are more important matters to handle right now with the state of our economy. But I bet you anything that if those people were laying in those beds they would be soo grateful that you took the chance and the time and the energy against all that negativity to try to make things better for them. Im not upset. Im heartbroken about what I have seen. Dee


207 Posts

Specializes in CNA. Has 5 years experience.

"..You say most CNAs dont seem to understand finances ( Im assuming you are suggesting that they are uneducated) but I understand very well...".

Not meant to be personal. And I didn't say finances, I said 'business'.

Yes, CNA's, and really, the general population, IS ignorant of business. Most of this country cannot balance their checkbook --- fact based on survey-after-survey.

Few people understand terms as 'overhead', back office, fixed expense, fixed and variable costs, break-even point, capital, cash flow, etc. These are basic, '101' business terms that you need to understand in order to run a business, especially one that never shuts down.

I'm not going to give a business lecture, but I'll stand by my statement that the average person, let alone a CNA, does not understand how to 'read the numbers' of where they work. Yes, I can read an income statement and few of us are privy to them, especially if you work for a private firm.


41 Posts

i am not asking for better pay for cnas. its a 1 month course. the pay fits the training.


i cannot believe that statement !!!

the pay does not fit the job, or the training. not all of us had a 1 month course, i had a 13 week course that if you bothered to study you actually did learn things pertaining to the care of the patient. not to mention the clinicals spent in the hospitals that i did were unpaid. we had plenty of good experiences in clinicals, when we were there it was vacation time for most of the ones who were supposed to be teaching us.

our pay is well below what it should be, being a cna is a demanding job in more ways than one & and very often thankless. the rn's get their credit due them, while most of the time cna's don't ~~ i am not taking anything away from rn's as i know they have worked long & hard, but where would they be without the help of the lowly cna's???

i myself am not in it for the money, i am in this for my love of the elderly but it would be nice to be paid more as well. i have worked in a rest home & there were 58 residents there, and 3 ( and sometimes if we were lucky 4 ) cna's per please tell me you don't think that is demanding work. would you like to work for $ 7.50/8.00 an hour? and before you tell me the overhead of the homes/agencies please do not bother as my best friend's sisters owned the rest home i worked at & all of them are financially set. they all have nice homes/vehicles & a lake house. i am not saying they are living like the rockefellers, but they could have afforded to have paid their employees more for the hard work they did.

Has 12 years experience.

First of all I would never work as a CNA for $7.50 an hour. That is your own doing and choice. Get a different job because you can make way more than that in other fields with just as much training. You had the same training as I . Its only a 100 hour course. Nomatter how you stretch it out. I went full time so my course was shorter but same hours. Most CNAs I know get $10 an hour and for 100 hours of training that is fitting. It goes up with additional training and experience. What your really upset about is the work load and that is what I am trying to address. The patient to aid ration makes the job demanding but as far as "skills" goes it is not that demanding of a job. I am not putting you down, just being real. I have been a CNA for 20 years. I know. Dee

Has 12 years experience.

I'm not going to give a business lecture, but I'll stand by my statement that the average person, let alone a CNA

Yes, let alone a CNA. You just had to add that right? For what reason? Nothing personal to insult a person . Ok. Whatever you say. Please dont post on this thread unless you can leave your own personal predujices out of it. Thanks Dee

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