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Today more than 1 million nursing assistants provide as much as 90 percent of hands-on care in nursing homes and other settings. This group is among the top 10 fastest growing occupations, according to the Bureau of Labor Statistics.

Despite the growth in the industry and the increased demand for talented workers, there is a long-term care workforce crisis. A myriad of issues contribute to this crisis:

  • Insufficient staff
    The single biggest problem is that there simply is not enough staff with sufficient time to provide good care. A survey by the Iowa Caregivers Association found that 57 percent of direct care workers have considered leaving their jobs. The most common reason was short staffing. The second was inadequate pay and benefits.

  • Low wages
    Nursing assistants, attendants, orderlies, home health aides and personal care aides earn $7.56 an hour. This rate is lower than retail sales wages of $8.64 per hour and unskilled factory earnings of $10.30 per hour.

  • Inadequate benefits
    Direct care workers have few, if any, essential benefits including health insurance, retirement plan, paid leave or child care.

  • A devalued job
    Direct care workers receive inadequate training, little or no recognition and few career advancement opportunities.

With 14 million people expected to develop Alzheimer's disease by the middle of the 21st century, all of whom will eventually require total care, a solution to the workforce crisis must be found immediately.

Our position

Three basic components determine quality of care for a person with Alzheimer's disease in any setting. The Alzheimer's Association advocates for legislation addressing these components:

  1. sufficient staffing levels
  2. adequately compensated staff
  3. proper training including dementia-specific training

What we are doing

Alzheimer's Association chapters work with lawmakers throughout the country to improve quality of care for a person with Alzheimer's disease across settings. Recent Association victories on long-term care workforce include:

  • Georgia 2002
    Advocates worked closely with the state legislature and Coalition for the Elderly to secure $96,000 for dementia training through 26 family and professional workshops across the state.

  • Georgia 2001
    The legislature adopted a resolution providing nursing facilities up-front incentives and wage pass-throughs to increase the number of staff above federal minimum requirements. It also urged provision of incentives to assist facilities in recruiting, training and retaining appropriate direct care staff.

  • Florida 2001
    Legislation was approved requiring all direct care workers of residents with dementia to receive one hour of dementia training within the first three months of employment and an additional three hours of training within nine months. Other issues addressed in the bill include increased continuing education and in-service training of Certified Nurse Aides (CNAs) and higher staffing ratios in nursing homes.

  • California 2001
    Alzheimer advocates sponsored, and were instrumental in the passage of, the Dementia Training Standards Act requiring California's 1,200 licensed skilled nursing facilities to provide all CNAs with two hours of dementia-specific training within the first 40 hours of employment. They are also required to develop a dementia-specific training component within existing orientation programs and provide five hours of dementia-specific in-service training per year.

To find out more about your state's advocacy on workforce issues contact your local chapter of the Alzheimer's Association.


Alzheimer's Association

Our vision is a world without Alzheimer's
Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.