Working in Nursing Homes

Nursing home care is extremely labor intensive. To provide this care, nursing homes rely almost solely on nursing assistants (who often have no training) augmented by licensed practical nurses (who have completed approximately one year of classroom and clinical training).

Nationally, nursing assistants (half of whom work in nursing homes and one-quarter in hospitals) form one of the largest and fastest-growing health care occupations. Almost all are women, and most are nonwhite. Many come from Africa, Asia, or Latin America and are not native English speakers. As a result, as a group they have little ability to fight for better working conditions. Currently, nursing assistants earn a median income of $27,000.

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To understand the life of nursing home residents and the nursing assistants who care for them, sociologist Timothy Diamond became certified as a nursing assistant and worked for several years in a variety of nursing homes. He soon concluded that the core of working as a nursing assistant is caregiving but that those who train nursing assistants don’t recognize this basic fact. Instead, his instructors taught him to recite biological and anatomical terms, measure vital signs, and perform simple medical procedures. Instructors divorced these skills from any social context or any sense that their patients were people rather than inanimate objects. Moreover, the skills Diamond most needed were never taught, such as exactly how do you clean an adult who has soiled a diaper in a manner that preserves the individual’s sense of dignity? Only by labeling this caregiving as mere physical labor could those who hire nursing assistants label them “unskilled” and treat them so poorly.

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