Assisted Living Careers
Professional caregiving is generally a stable, high-demand career in the U.S. But you may not have heard that job openings in geriatric caregiving are expected to multiply by up to 47 percent in the next seven years — at more than six times the speed of the average occupation.
| Professions in elder care | Projected growth 2016 – 2026 |
| Home Health Aide | 47% |
| Personal Care Aide | 39% |
| Healthcare Social Worker | 20% |
| Certified Nurse’s Aide | 12% |
| Average of growth rate of all other jobs | 7% |
Sources: The Bureau of Labor Statistics — Home Health Aides and Personal Care Aides;Nursing Assistants and Orderlies; Social Workers
This is great news for any job seekers trying to break into the industry, but with America’s elderly population skyrocketing as the baby boomers age, and with older generations of doctors retiring en masse, the U.S. has an eldercare shortage in its very near future.
Demand growth for healthcare aides between 2016 and 2026
Growth of 65+ population between 2010 and 2030
Growth of 75+ population between 2010 and 2030
Projected shortage of geriatricians by 2025
Sources: Census.gov; The American Geriatrics Society; The Association of American Medical Colleges; The Federation of State Medical Boards; The Bureau of Labor Statistics
What’s worse, the gap between filled and unfilled job openings in healthcare has been widening at an alarming pace since at least 2014. To keep up with our rising eldercare demand, American businesses would have to spend the next seven years hiring 2.3 million new healthcare workers, and the majority would need to be home health aides — a profession unlikely to pay more than $25,000 per year.
While it is well-documented that low average pay is a top contributing factor to healthcare workforce shortages, things may be about to change for caregivers serving the elderly. At the current pace of demand growth in geriatric care, direct care workers’ salaries — which have been rising slowly since 2004 — could grow more quickly in a rush to fill the widening eldercare gap on the horizon for 2024.
Higher income geriatric care professionals are also likely to see their market share rise. The Bureau of Labor Statistics has found that people who work in the social work and care management industries will generally see a job market boost of up to 20 percent by 2026. But if the statistics we’re seeing for other geriatric care jobs are any indication, care management and social work professionals who specialize in geriatrics may see even greater gains than other specialists in these fields.
| Industry | Projected growth 2014 – 2024 |
| Healthcare and Social Services | 21% |
| Construction | 13% |
| Private Educational Services | 10% |
| Professional and Business Services | 10% |
| Mining | 10% |
| Leisure and Hospitality | 6% |
Did you know?
The healthcare and social services industry will lead American job growth by a wide, 8% margin within the next six years.
This guide will explore the career prospects of geriatric social workers, home health aides, personal care aides and certified nursing assistants. Read on to find out about the qualifications, salaries and day-to-day realities of this fast-growing industry.
What Is a Caregiver?
While the title of caregiver can belong to people who take custodial responsibility for a family member, friend or neighbor, the term is used to describe a broad range of formal career paths in service of the medically needy — and that more narrow definition is what we’ll focus on in this guide. Care professionals help people with diminished physical capacities maintain their health and safety, and stay active in their lives. This may involve providing assistance with personal grooming, medication management, dietary maintenance and many other acts of personal support.
Is Caregiving Right for Me?
The physical and emotional involvement of caregiving can be exhausting when added to the many functional obligations of being responsible for another adult. It is for this very reason that having the assistance of a professional is often vital for people facing physical or mental decline. Caregiving can be an extremely rewarding line of work for people who are adaptable, comfortable working with others and passionate about helping vulnerable individuals.
The following personality traits and abilities are instrumental to effective caregiving.
Emotional maturity is arguably the most important ability in a caregiver’s arsenal, and one that can be developed with focused effort.
Clients of caregivers are often people who are at their most needy, and supporting them may mean dealing with situations that an average person would find uncomfortable, stressful or even disturbing. You can imagine why caregivers who try to face their job without emotional grit rarely last long. The exceptional depth of care and understanding that clients require necessitates a wide range of traits deeply related to emotional maturity.
Core aspects of emotional maturity that caregivers must demonstrate include:
- Self-control — maintaining calm under stress
- Compassion — a genuine interest in helping those who need you
- Patience — dealing with the instability of others
- Rationality — ability to be shrewd and use sound logic
- Dependability — always sticking to commitments
- Integrity — honesty and ethical responsibility
- Empathy — personal acceptance of the human condition
A caregiver must always strive to know what their client needs, making communication and listening skills extremely important.
Aged and medically vulnerable people may not be able to communicate effectively due to diminished physical or mental capacities. But even under these difficult circumstances, caregivers must maintain open communication with clients and their families, and also with doctors, nurses and therapists. When caregivers work effectively as part of a team, their clients and loved ones see overwhelmingly more positive health and longevity outcomes.
Important communication skills for caregivers include:
- Learning client communication style
- Communicating with clients who cannot hear or speak clearly
- Keeping written records of events and preferences
- Supporting and educating family and friends
- Understanding complaints of physical or emotional change
- Learning and assessing client or family preferences
- Maintaining cooperative relationships with other healthcare specialists
Working with vulnerable people involves an element of risk — both for the professional and the client.
Clients who have diminished abilities to communicate may not be able to alert a caregiver if they sense a problem. For caregivers to limit risk for their clients, they must be vigilant and capable of clear thinking. Details as small as pupil dilation, mood swings and a worsening of skin condition can be subtle indicators of a turn in health, and most certified healthcare professionals are trained to spot them.
Ways that caregivers can exercise attention to detail include:
- Assessing skin condition
- Carefully reading all medication labels
- Monitoring vital signs
- Keeping fastidious records
- Maintaining accuracy at all times
- Observing signs of abuse or neglect
- Using inductive reasoning to assess the big picture
While not all jobs in caregiving require the same level of physical effort, this field is well-known for being taxing on one’s stamina.
The act of caregiving is about lending your time and your physical, emotional or mental stability to people who cannot thrive on their own. This can involve long days spent driving your clients to appointments and errands, doing housekeeping, providing physical therapy or therapeutic massage, and lots more. The stress alone of taking on all that responsibility can have consequences for a person’s energy level.
Energy-intensive activities commonly involved with caregiving include:
- Lifting, positioning or carrying another person
- Changing linens of occupied beds
- Light housekeeping
- Long hours of driving
- Standing and walking for long hours
- Exercise and activity assistance
- Assistance with personal grooming
Caregiver Professions
The following are four popular and high-demand careers listed from the lowest average income to the highest. For a detailed description of each profession including the duties involved, average salary and necessary skills training, click on the job title in the table below.
| Career | Average Hourly Income | Job Description |
| Personal Care Aide | $11.11 | Personal care aides monitor and assist physically and/or mentally dependent individuals with activities of daily living (eating, bathing, dressing, toileting etc.), instrumental activities of daily living (housekeeping, budgeting, laundry, errands etc.) and social or physical activity engagement. |
| Home Health Aide | $11.16 | Like personal care aides, HHAs monitor and assist physically and/or mentally dependent individuals with activities of daily living, instrumental activities of daily living and social or physical activity engagement. HHAs may also perform minor medical tasks such as medication administration or basic wound care. |
| Certified Nurse’s Assistant | $13.23 | CNAs perform the same tasks as home health and personal care aides but are directly supervised by a registered nurse or licensed practical nurse, and thus may act on their behalf in some situations. Nurse’s Assistants are also tasked with monitoring the vitals and health/mental status of patients in care settings, and may make use of basic medical equipment, supplies and techniques. |
| Geriatric Social Worker | $27.31 | Geriatric social workers are like healthcare advisors, service coordinators and emotional support specialists all rolled into one. They visit with clients to facilitate access to services and supports, and to provide advocacy, self-care education, scheduling, and crisis management. Many are also qualified to monitor the stability of a client’s health and wellness and can be instrumental in maintaining a comprehensive care plan. |
Personal Care Aide
| Career Outlook & Requirements | Personal Care Aide |
|---|---|
|
Mean Yearly Salary |
$23,100 |
|
Common Job Titles |
|
|
Required Education |
No national standard exists. |
|
Required Training |
Training requirements are determined by state governments, certifying bodies and/or individual employers. |
|
Required Credentials |
State governments and employers sometimes require PCAs to complete a 75-hour competency evaluation program normally used to certify home health aides. |
|
Optional Certifications |
|
|
Projected Job Growth |
39% (2016 – 2026) |
What Do Personal Care Aides Do?
While training for this position is usually minimal compared to more specialized healthcare careers, personal care aides spend more time with their clients than doctors, nurses or even therapists. Helping vulnerable people handle the normal parts of their everyday lives that have become too challenging to face alone is an aide’s main concern.
People who require the services of a PCA may need only a basic level of assistance, without which they would not be able to avoid being institutionalized in a nursing home. In this way, PCAs represent the middle ground between nursing homes and independent living. Their work ensures that long-term care institutions are reserved for the people who need them most, and that those who still have some chance of maintaining their independence can do so for as long as possible.
Common Job Requirements
Personal care aides can work in a wide variety of settings, though the majority find employment in individual and family homes, home health agencies or residential care communities. PCAs provide everyday assistance to long-term residents of these settings but do not perform any sort of medical care. Some PCAs are trained and supervised by home health aides or certified nursing aides to provide more health-focused assistance, but most predominantly function as activity guides and physical aides.
Common skills and duties of personal care aides include:
- Assisting clients with activities of daily living
- Assisting clients with instrumental activities of daily living
- Providing emergency assistance
- Physically transferring clients from reclined positions
- Performing light housekeeping
- Providing limited medication assistance
- Facilitating physical and social activity
- Assisting with scheduling and budgeting
- Using exceptional interpersonal skills and patience
Did you know?
The clients of PCAs often have plans of care in place, and they are indispensable for aides who work with multiple clients a day. Sometimes called individual service plans, these documents are established by a person’s doctors, therapists and nurses to help caregivers coordinate a client’s healthcare needs. Service plans also establish boundaries that maintain a person’s independence and personal preferences, and help caregivers prevent avoidable problems like over- or under-medication and the mishandling of emergencies. Carefully following the plan of care is a daily priority for PCAs.
Career Outlook
While home health aides will see the most significant increase in healthcare job openings between now and 2026, personal care aides will probably be a close runner-up. There are now more than 2,035,000 PCAs employed in the United States, but due to accelerating population growth and upward trends in home care, the need for PCAs is likely to increase by over 39% very soon. International healthcare consultancy Mercer projects that this extensive growth in the direct care industry will likely result in hundreds of thousands of unfilled positions by 2025, making the need for personal care aides all the more urgent.
Growth of American Jobs: 2016 – 2026
All American Jobs
Personal Care Aides
Home Health Aides
Source: The Bureau of Labor Statistics — Home Health Aides and Personal Care Aides; Nursing Assistants and Orderlies
Job Demand
In 2017, the five states most likely to hire personal care aides were California, Texas, New York, Pennsylvania and Massachusetts. It’s estimated that New York will see the highest quotient of new job creation for personal care aides by 2026, while nearby New Jersey will offer one of the country’s highest average salaries for PCAs.
| States With the Most Working PCAs | Number of PCAs Employed in 2017 |
| California | 520,660 |
| Texas | 196,790 |
| New York | 166,760 |
| Pennsylvania | 109,980 |
| Massachusetts | 73,950 |
Source: The Bureau of Labor Statistics — Personal Care Aides
Salary
Median incomes for personal care aides are at a modest nationwide average of $11.11 but can vary widely in different states. Between the five states that currently hire the most personal care aides, seen above, the average pay rate is higher at $11.97 per hour. However, among the highest-paying states in the country, PCA salaries can exceed that number by more than $3 per hour.
| States That Pay the Highest Salaries | Mean Hourly Wage | Mean Annual Salary |
| North Dakota | $15.37 | $31,970 |
| Alaska | $15.34 | $31,910 |
| District of Columbia | $14.10 | $29,330 |
| Massachusetts | $13.85 | $28,810 |
| New Jersey | $13.76 | $28,620 |
Source: The Bureau of Labor Statistics — Personal Care Aides
Hospitals and state-owned institutional settings, such as Veterans’ Affairs clinics, may pay personal care aides up to $6 more per hour than the average PCA wage, depending on factors like years of experience and certification. Wage disparities are sometimes caused by PCAs getting predominantly part-time work in some industries, thus necessitating a higher hourly compensation.
| Highest Paying Industries | Mean Hourly Wage | Mean Annual Salary |
| State Government, excluding schools and hospitals (OES Designation) | $17.73 | $36,890 |
| General Medical and Surgical Hospitals | $13.87 | $28,850 |
| Psychiatric and Substance Abuse Hospitals | $13.71 | $28,520 |
Source: The Bureau of Labor Statistics — Personal Care Aides
Education, Training and Certification
Training and Educational Requirements
Most PCAs competing in today’s marketplace have at least a high school degree or GED. However, there is no nationally mandated training or suite of educational prerequisites for personal care aides. It is possible to find training courses in community colleges or vocational schools, but employers often see to it that their PCAs receive most of their skills training on the job — a practice called in-service training.
For aides who work in facilities licensed to receive Medicare and Medicaid, the federal government requires infection control training, and state governments may require additional certificates as well. Yearly updates are required for infection control education, as well as for most certificates applicable to this field.
Certification
Some states and employers may require personal care aides to pass a competency exam intended for home health aides, but aside from that, most PCAs never pursue independent certification. For those that do, however, there are a few well-respected organizations at the national level that offer certificates to people in healthcare support positions.
Optional certificates are a proactive way to make job applications more attractive to employers, and studying for a certificate exam can also reduce job-related stress by imparting higher competence and greater confidence in one’s abilities. These programs usually take less than a year to complete and most of them require only modest fees to participate.
CPR Certification with the American Red Cross
One of the most accessible certifying bodies in the country for direct care workers is the American Red Cross. Their OSHA certified courses are broadcast online and available in person at ARC facilities, with over 550 designated teaching locations across the country. There are courses available on CPR, first-aid, defibrillator use and lifeguarding, and ARC credentials are accepted by most employers of personal care aides.
A Red Cross certification can be completed in a few days and there are no prerequisites for enrollment. Once a certificate is earned, students must retake their courses every two years, paying the regular fee each time. Pricing is dependent upon attendance style, with online-only priced at $30 and in-person courses priced at $113. The ARC suggests that students use a combination of online and in-person attendance. The combination is priced at $300.
To find courses near you, use the Red Cross class lookup tool available on RedCross.org.
The National Certification Council for Activity Professionals
The NCCAP awards certificates for activity assistants, directors and consultants who work in residential or long-term care settings. Activity specialists engage people who are losing functionality of the mind or body in exercises and events that support their well-being. Many retirement communities and skilled care facilities hire activity organizers, and some states require long-term care settings to have at least one on staff.
The NCCAP’s proprietary coursework includes options to specialize in specific care settings, such as home care, memory care and assisted living. The basic activity professional course load results in a combination of credentials based on students’ choice of specialty, and most certificates require less than a year to complete. A fee is charged for each certificate earned, and an annual fee is assessed for renewals.
Visit the NCCAP online to view the fee schedule for certificates as well as coursework and standards.
Home Health Aide
| Career Outlook & Requirements | Home Health Aide |
|---|---|
|
Mean Yearly Salary |
$23,210 |
|
Common Job Titles |
|
|
Required Education |
No national standard exists, but most HHAs have earned a GED or high school diploma. |
|
Required Training |
State governments and individual employers designate their choice of organization to administer 75 hours of competency training. |
|
Required Credentials |
HHAs must pass a state-administered competency evaluation to serve Medicare and Medicaid recipients. |
|
Projected Job Growth |
47% (2016 – 2026) |
What Do Home Health Aides Do?
Home health aides perform many of the same tasks as PCAs, like assisting clients with grooming and mobility. But there are a few key differences between personal care and home health aides, the most notable being that HHAs are often more qualified to handle basic medical maintenance, such as wound dressing or catheter assistance.
HHAs commonly find themselves in close physical contact with the people they serve. While this does mean that they must be in good physical condition to handle the frequent load-bearing maneuvers of caregiving, it also warrants a good bedside manner and highly developed self-control. Some people are naturally better predisposed to this kind of work than others, but with the right skills, training and preparation, this position can become a far more accessible career path.
Common Job Requirements
HHAs are trained to offer a wide range of health and wellness services, and while they may be self-employed, they’re most often hired by agencies and deployed to assisted living facilities and other care settings. Home health aides typically do not provide 24-hour care and cannot administer the level of skilled care that a nurse can legally offer.
Common skills and duties of home health aides:
- Counsel and support family caregivers
- Assist clients with activities of daily living
- Assist clients with instrumental activities of daily living
- Assist clients with exercise regimens
- Record vital signs and visible changes in health
- Practice infection prevention and control
- Provide medication assistance or administration
- Practice emergency preparedness
- Perform basic health maintenance (bandaging, dental care etc.)
- Facilitate physical and social activity
- Demonstrate exceptional interpersonal skills
- Lift at least 30 pounds and stand/walk for long periods
- Possess extensive patience
- Read and speak English fluently
Did you know?
The administration of prescriptions is taken very seriously in care settings as even the smallest mistake can have dire consequences. Home health aides may be authorized to administer medicines to clients who cannot do so for themselves, though training and certification are usually required. State regulation of the practice can be deeply specific, often parsing details like whether an aide is permitted to open packaging or remove medicines from packaging once they have opened it. For reasons like this, an intimate knowledge of state law is required for HHAs to function in their caregiving roles on a daily basis.
Career Outlook
As residential facilities and home care continue to gain popularity, home health aides will find more opportunities for both traditional and self-employment. In fact, home health aides will see the most job openings of all healthcare professionals over the next decade. There are now more than 900,000 people working as HHAs in the U.S., but over 1 million new HHA jobs may become available by 2027.
Growth of American Jobs: 2016 – 2026
All American Jobs
Personal Care Aides
Home Health Aides
Source: The Bureau of Labor Statistics — Home Health Aides and Personal Care Aides; Nursing Assistants and Orderlies
Job Demand
A closer look at employment numbers reveals where home health aides have been most likely to find job openings since 2017. Among them are three states — New York, Texas and Ohio — that analysts at Mercer predict will have the greatest demand growth for HHAs in the country by 2022.
| States With the Most Working HHAs | Number of HHAs Employed in 2017* |
| New York | 193,460 |
| Texas | 76,370 |
| Ohio | 59,010 |
| New Jersey | 41,200 |
| Pennsylvania | 34,740 |
*These figures do not include self-employed aides
Source: The Bureau of Labor Statistics — Home Health Aides
Salary
In the United States, the average home health aide can expect to bring home an hourly wage of about $11.17. However, HHAs can make about $4 more per hour in North Dakota, Alaska, California, Massachusetts and Delaware — the five highest-paying states for home health aides.
| States That Pay the Highest Salaries | Current Mean Hourly Wage | Current Mean Annual Salary |
| North Dakota | $16.32 | $33,940 |
| Alaska | $15.55 | $32,350 |
| California | $15.20 | $31,610 |
| Massachusetts | $14.78 | $30,740 |
| Delaware | $14.07 | $29,270 |
Source: The Bureau of Labor Statistics — Home Health Aides
The businesses that currently hire the most HHAs are home health agencies, individual/family service providers and retirement communities for the elderly. However, the care settings where these professionals find the highest paying jobs are psychiatric/substance abuse hospitals, social advocacy organizations and state government institutions like the VA.
| Highest Paying Industries for HHAs | Number of HHAs Employed in This Industry | Mean Hourly Wage | Mean Annual Salary |
| Psychiatric and Substance Abuse Hospitals | 1,110 | $16.99 | $35,340 |
| Social Advocacy Organizations | 1,470 | $13.97 | $29,050 |
| State Government, excluding schools and hospitals (OES Designation) | 9,960 | $13.55 | $28,190 |
| General Medical and Surgical Hospitals | 8,380 | $13.19 | $27,430 |
Source: The Bureau of Labor Statistics — Home Health Aides
Education, Training and Certification
Training and Educational Requirements
An important part of becoming a home health aide is finding out about your state’s legal requirements for the position. While little to no formal education is needed to become an HHA, the federal government does require state-administered certification and infection control training for those who work with Medicare and Medicaid recipients. Given that most, if not all home health agencies do work with these demographics, getting certified is a normal part of the job. Training programs must be at least 75 hours long and include both classroom and in-service work.
Training for HHAs is regulated by the federal government in what curriculum must be included, but there are very few requirements placed on where or how the actual training is done. States are free to establish higher training standards and to select organizations to administer formal training, but some states allow employers to arrange their own training programs. This is perfectly legal, as long as employers ensure that a registered nurse (RN) directly oversees home health aide education and exams.
Topics and activities covered in home health aide competency training include:
- Effective communication
- Patient observation and record keeping
- Taking vital signs
- Infection control and prevention
- Elements of healthy and unhealthy body functioning
- Maintaining a clean, safe and healthy environment
- Recognizing and handling emergencies
- Population-specific education
- Performing specific grooming tasks
- Techniques of safe physical transference
- Normal range of motion and positioning
- Dietary maintenance
- Recognizing changes in skin condition
Certification
Once training is completed, most HHAs take a state-regulated competency evaluation exam designed for direct care personnel. The exam is administered by registered nurses — usually, the same nurses who oversee training programs. Aides are tested on their knowledge of each major topic that they covered in competency training, seen above.
Tests are partly comprised of a written portion and partly of a practical demonstration. If an aide fails one ‘topic module’ of the exam, they may be provisionally certified if further training is provided. However, if more than one topic is failed, the competency exam is failed overall and must be repeated. To maintain certification in the long-term, HHAs who pass their exams must perform about 12 hours of continued in-service training every year.
Certified Nurse’s Assistant
| Career Outlook & Requirements | Certified Nurse’s Assistant |
|---|---|
|
Mean Yearly Salary |
$27,520 |
|
Common Job Titles |
|
|
Required Education |
No national standard exists, though most CNAs have a GED or high school degree. |
|
Required Training |
Minimum training requirements are federally regulated, but requirements that exceed the minimum are determined by state governments and certifying organizations. |
|
Required Credentials |
Training, certification and registration are completed through employers, schools, healthcare providers or through your state’s choice of formal training organization. Most states use one of the following certifying bodies: |
|
Optional Certifications |
|
|
Projected Job Growth |
11% (2016 – 2026) |
What Do Certified Nurse’s Aides Do?
CNAs are supervised by nurses or doctors, and they provide routine assistance to patients receiving medical care. Like HHAs and PCAs, nurse’s aides have a high level of interpersonal responsibility and very commonly work with the elderly. However, this position involves a slightly higher level of medical specialization.
A certified nurse’s aide, sometimes called a nursing assistant, is most likely to be employed in a skilled care facility (a nursing home). CNAs in nursing homes regularly monitor and assist medically vulnerable patients, seeing to it that their environment is kept safe and clean, and that even subtle health changes are reported. Many CNAs move on from this position to eventually become licensed practical nurses or registered nurses.
Common Job Requirements
These professionals handle many technical and interpersonal functions in their line of work, but key skills are related to the heightened vulnerability of the people they help. It is common for nursing aides to be responsible for monitoring the status of patients for whom death is imminent or whose health is highly precarious, making standardized and regularly updated training very important for CNAs.
Common skills and duties of nurse’s aides:
- Handling biowaste and avoiding cross-contamination
- Infection control
- Use of medical maintenance and analysis equipment
- Communicating with people of diminished sensory capacities
- Physical transference of medically vulnerable people
- Managing and systematically recording patients’ food and liquid intake
- Medication administration or assistance
- Changing linens of occupied beds
- Turning and positioning bedridden clients
- Dietary patient care
- Daily monitoring of patient health and stability
- Assistance with activities of daily living
- Basic medical maintenance tasks
- Working with a team of healthcare professionals
Did you know?
CNAs are responsible for maintaining patients on a day-to-day basis, which makes the records they create a vital part of effective patient care. At the end of a shift, it is up to the CNA to make sure they have recorded even subtle changes in a patient’s habits throughout the day, as well as any intake of medicines, foods and liquids. Learning proper record keeping techniques and effectively communicating with supervisors, co-workers and clients can save the lives of those under a CNA’s care.
Career Outlook
Between 2016 and 2026, the demand for registered nurses and licensed practical nurses is poised to grow by 15 percent and 12 percent respectively, so employment of certified nursing assistants must grow as well. The Bureau of Labor Statistics estimates that there will be nearly 175,000 new jobs for nursing assistants by 2026.
While this profession’s projected 10-year growth of 11 percent seems only slightly faster than average, healthcare consultancy Mercer predicts that as much as one-fourth of all new job openings for nursing assistants may remain unfilled by 2025. Due to the low supply of new nursing assistants relative to increasing demand, this field will offer a higher level of job security and a greater availability of employment options than many other professions over the next decade.
Growth of American Jobs: 2016 – 2026
All Professions
Certified Nurse’s Aide
Licensed Practical Nurse
Registered Nurse
Source: The Bureau of Labor Statistics — Nursing Assistants; Licensed Practical Nurse; Registered Nurse
Job Demand
CNAs are most likely to be hired in high-population areas, and five states in particular — California, New York, Florida, Texas and Pennsylvania — have the greatest need for employment in this profession. California, the largest employer of nurse’s aides, is also where CNAs are paid the highest salaries.
| States With the Most Working CNAs | Number of CNAs Employed in 2017 |
| California | 98,570 |
| New York | 94,980 |
| Florida | 92,190 |
| Texas | 88,500 |
| Pennsylvania | 75,020 |
Source: The Bureau of Labor Statistics — Nursing Assistants
Salary
The nationwide average income for a CNA is $13.72 per hour. However, among the five states that hire the most CNAs in the country, the average salary is greater at $14.52 per hour. In the areas where certified nursing assistants are paid the highest salaries — Alaska, New York, Nevada, the District of Columbia and California — the average hourly pay is $16.85.
| States That Pay the Highest Salaries | Mean Hourly Wage | Mean Annual Salary |
| Alaska | $18.24 | $37,950 |
| New York | $16.87 | $35,080 |
| Nevada | $16.58 | $34,480 |
| District of Columbia | $16.43 | $34,170 |
| California | $16.13 | $33,560 |
Source: The Bureau of Labor Statistics — Nursing Assistants
While the businesses most likely to hire certified nurse’s aides are skilled nursing facilities, hospitals and continued care retirement communities, there are other places where a CNA can make significantly more money. By far, the greatest earning potential for this profession can be found in Veterans’ Affairs clinics and other organizations owned by the federal government.
| Highest Paying Industries | Mean Hourly Wage | Mean Annual Salary |
| Federal Executive Branch (OES Designation) | $18.43 | $38,340 |
| Scientific Research and Development Services | $17.42 | $36,240 |
| Colleges, Universities, and Professional Schools | $16.49 | $34,290 |
Source: The Bureau of Labor Statistics — Nursing Assistants
Education, Training and Certification
Training and Educational Requirements
CNA training follows standards established by the federal government, but how this training is delivered is left to the states to decide. In most states, there is likely to be a designated organization responsible for accrediting training programs and administering final CNA exams. Before becoming certified, nurse’s aide candidates must complete a course of practical and classroom training. Candidates who complete their training must then take exams that include a written portion and a practical demonstration of what they’ve learned.
States vary on how many total hours of coursework they require for nursing aide certificates, but most require candidates to complete between the minimum 75 hours and up to 180 hours to be eligible to register for CNA exams. The clinical skills portion of training consists of supervised work experience, and generally takes between 16 and 100 hours.
According to Cornell University’s Legal Information Institute, the federal government requires CNA training programs to cover:
- Communication and interpersonal skills
- Infection control
- Safety/emergency procedures (including the Heimlich maneuver)
- Promoting and respecting client rights and independence
- Taking and recording vital signs
- Caring for clients’ environment
- Recognizing abnormal health changes
- Caring for the dying
- Personal care skills, like bathing, dressing, toileting and transference
- Patient-appropriate social interaction
- Care of cognitively impaired clients
- Care and use of prosthetic and orthotic devices
- Range of motion maintenance
- Proper turning and positioning in beds and chairs
Fees for enrollment in CNA training are unlikely to exceed $2,000. To become enrolled, prospective CNAs must submit materials to their state’s relevant training and/or certifying bodies, such as a state ID, a high school diploma or GED, proof of physical examinations and immunizations, tuberculosis test results and an authorization for a background check.
Prerequisites for enrollment vary depending on the certifying body employed by your state. For example, unlike the National Council of State Boards of Nursing, the American Red Cross requires applicants to be pre-certified in first-aid and CPR, which are courses that they conveniently offer for a small fee of between $130 and $300 apiece.
Certification
Once training is completed, testing is often provided by the American Red Cross or the National Council of State Boards of Nursing which, together, offer most of the country’s CNA training. CNA certificate exams in the U.S. consist of a written test and a clinical skills examination. The practical portion of exams involves a demonstration of skills using a mannequin or a fellow student, and always begins with an exhibition of proper handwashing procedures. Although the organizations which grant nurse’s aide certificates differ by state, there are federally mandated requirements for their pass/fail criteria and what subjects they must cover.
Practical exams take about 30 minutes and require students to demonstrate three to six skills, frequently including:
- Taking vital signs
- Catheter care and assistance
- Performing a sponge bath
- Transference (bodily moving a client to or from their bed)
- Dental care
- Making an occupied bed
The National Council Licensure Examination for Practical Nurses
The next step up the professional ladder for CNAs is to become a licensed practical nurse. Sometimes called licensed vocational nurses, these caregiving professionals do much of the same work as CNAs, and yet they make almost twice as much money. Of course, with higher pay comes a greater level of responsibility. If a CNA becomes an LPN, they can expect their work to be more focused on medical processes, and supervision by other licensed nursing personnel may be less prevalent.
Becoming an LPN/LVN usually takes about a year of preparation and involves enrollment in a certificate or associate degree program. Those who eventually want to become RNs might find that an associate degree is ideal for them, but the fastest way to capitalize on the greater earning potential of an LPN is the certification route. On finishing a degree or certificate program, prospective LPNs apply to take a licensing exam called the NCLEX from the National Council of State Boards of Nursing — the same organization that certifies CNAs in many states.
The APIC Certification in Infection Control
Optional certifications may be extremely helpful for nurse’s aides who wish to move into supervisory roles. The Association for Professionals in Infection Control and Epidemiology is accredited by the American Nurse’s Credentialing Center, and offers infection control certificates to healthcare consultants and supervisors. Applicants must have at least an associate degree to participate and two years of experience in a supervisory or consulting role in clinical healthcare.
APIC offers a free Candidate Handbook that serves as a study guide for the final exam. The fee for exams is $375, and for most candidates, a testing location can be found nearby. To maintain certification, the test must be repeated every five years, and the same fee of $375 must be paid each time exams are re-taken. Unlike the initial exam, re-certification testing can be taken online and is open-book.
Geriatric Social Worker
| Career Outlook & Requirements | Geriatric Social Worker |
|---|---|
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Mean Yearly Salary |
$56,810 |
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Common Job Titles |
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Required Education |
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Required Training |
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Required Credentials |
Licensing for the practice of social work is regulated by state governments. Requirements for licensure may vary. |
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Optional Certifications |
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Projected Job Growth |
20% (2016 – 2026) for all healthcare social workers |
What Do Geriatric Social Workers Do?
A geriatric social worker (GSW) is a type of healthcare social worker — a professional who personally supports the well-being of vulnerable people through the enablement and coordination of their healthcare. They are clinical health and aging advisors for family caregivers, as well as management professionals who arrange care and services for elderly clients.
Depending on a GSW’s level of experience, they may work independently or within a range of organizations, though they most often find themselves in the homes of clients or in long-term and residential care settings. GSWs come from many disciplines and educational backgrounds and may establish themselves in other industries related to geriatrics as their careers progress, such as medical facility management or nonprofit work. GSWs are considered healthcare clinicians, making them payable via Medicare Part B.
Common Job Requirements
Due to the high adaptability of geriatric social workers to the needs of individual clients, the skill sets that they use can vary significantly. Generally speaking, social workers in the geriatric specialty focus on interprofessional communication, team-based interventions and person-centered approaches to helping clients live their best lives.
Common skills and duties of geriatric social workers:
- Self-management and the emotional support of others
- Ability to assess subtle changes in health or behavior
- Knowledge of common afflictions of the elderly
- Understanding of emotional and physical life cycle changes
- Ability to coordinate extensive services and events
- Knowledge of standards for institutional settings and healthcare providers
- General social work skills of at least a baccalaureate level
- Ability to create and understand an individual plan of care
- Select and manage care aides
- Coordinate and manage residential transitions
- Help to prevent accidents and disease
- Address barriers to healthcare access
- Offer educational counseling to family caregivers
- Long-term interpersonal connection
- Clear and competent communication skills
- High understanding of family dynamics
Did you know?
Geriatric social workers perform nearly the same function as geriatric care managers (GCMs), who may come from the same educational background or from a related field, such as psychology or nursing. Unlike geriatric social workers, GCMs have the option to practice without a license. If they are not licensed, however, care managers are not eligible to be paid through Medicare, making them less affordable than licensed geriatric social workers, who are predominantly paid through Medicare Part B.
Career Outlook
The National Center for Health Workforce Analysis projects that there will be a major shortage of geriatricians by 2025, with over 25,000 positions likely to remain unfilled. Multiple organizations, like Mercer and the Bureau of Labor Statistics, have likewise forecast shortages for other eldercare workers. With workforce shortages looming and significant increases in elderly populations on the horizon, it’s probable that there will be more job openings than ever for eldercare practitioners like geriatric social workers.
Geriatric social workers (GSWs) are healthcare social workers who serve the elderly. While some social workers only offer case management to help clients find and receive the help they need, healthcare social workers like GSWs are clinicians, providing treatment services such as direct family and individual counseling, healthcare interventions and assessment of health and wellness needs.
Healthcare clinicians in social work — and particularly those who specialize in working with the elderly — are likely to see greater demand than all other types of social workers by 2026. More family caregivers will be searching for geriatric social workers in the near future, not only to provide assistance to an aging loved
Growth of American Jobs: 2016 – 2026
All Professions
All Social Workers
Mental Health & Substance Abuse Social Workers
Healthcare Social Workers
Source: The Bureau of Labor Statistics — Social Workers
Job Demand
In keeping with employment trends for other caregiving professions, the greatest numbers of healthcare social workers are hired in California, New York, Massachusetts, Texas and Ohio. California and New York are projected to have outsized demand growth between now and 2026 for most professions related to geriatrics.
| States With the Most Employed Healthcare Social Workers | Number of Healthcare Social Workers Employed in 2017 |
| California | 18,150 |
| New York | 12,620 |
| Massachusetts | 11,540 |
| Texas | 9,980 |
| Ohio | 9,810 |
Source: The Bureau of Labor Statistics — Healthcare Social Workers
Salary
The Bureau of Labor Statistics reports that the average healthcare social worker makes about $27 per hour. However, the rising demand for geriatric specialists in all fields may cause hourly pay to be higher than average for social workers specializing in geriatrics. The five areas where healthcare social workers currently make the highest salaries are Nevada, California, D.C., Oregon and Connecticut.
| States That Pay the Highest Salaries | Current Mean Hourly Wage | Current Mean Yearly Salary |
| Nevada | $37.95 | $78,940 |
| California | $34.99 | $72,770 |
| District of Columbia | $33.93 | $70,580 |
| Oregon | $33.74 | $70,190 |
| Connecticut | $33.58 | $69,840 |
Source: The Bureau of Labor Statistics — Healthcare Social Workers
Healthcare social workers, including those specializing in geriatrics (GSWs), are most likely to be employed by hospitals, home healthcare agencies and skilled nursing facilities such as nursing homes and hospice care. General and surgical hospitals represent the largest hiring industry for healthcare social workers, and also happen to have one of the most competitive pay rates overall for this profession.
| Highest Paying Industries | Mean Hourly Wage | Mean Annual Salary |
| Management, Scientific, and Technical Consulting Services | $31.54 | $65,600 |
| Scientific Research and Development Services | $30.16 | $62,740 |
| General Medical and Surgical Hospitals | $30.05 | $62,510 |
Source: The Bureau of Labor Statistics — Healthcare Social Workers
Education, Training and Certification
Training and Educational Requirements
According to the American Geriatric Society, the Council on Social Work Education is the only reputable accrediting body for social work degree programs. The Council accredits about 500 Bachelor’s of Social Work programs in the U.S., and anyone wishing to become a geriatric social worker will begin their journey here, with the average time to graduation being three to five years.
After gaining a bachelor’s in social work, graduates who are still interested in going into this field will seek employment under a licensed professional — a practice called supervisory training. This is done to fulfill requirements for becoming licensed and/or certified and to get real-world experience. Supervisory employment typically lasts for about two years and is an opportunity for young professionals to learn by doing, and also to make connections with local employers.
The next step after, and sometimes during supervised training, is the completion of an accredited master’s program. A master’s in social work offers students the opportunity to choose their area of specialization, with gerontology being one of the best options for prospective geriatric social workers. The Council on Social Work Education accredits about 240 geriatrics master’s programs across the country, and these can typically be completed within about two years.
Certification
Licensing
The first step in becoming a fully-fledged social worker — getting licensed — is regulated by state governments. This means that requirements differ depending on where one begins their career. Unsupervised practice always requires licensure, and as a prerequisite for the licensing exams, most states require about 3,000 hours of supervised experience. Candidates must work with a credentialed professional for a year and a half to two years before they can even sign up for licensing exams.
While some states allow graduates of bachelor’s programs to test for their licenses once they finish the requisite hours of supervised training, most states also require the completion of a master’s degree. Though there are many different levels of licensure for social workers, and also many state-specific credentials available, the highest distinction in this field is the Licensed Clinical Social Worker (LCSW) credential. The LCSW requires a master’s degree and many hours of work experience, and it allows social workers to go into a fully independent, private practice.
Certification
Voluntary certifications are available, and are recommended for social workers in geriatrics. Having the extra credentials demonstrates that you are committed to continually educating yourself, which is a fundamental part of practicing social work. The certifying bodies that provide credentials for GSWs also offer employment and educational resources, and can advertise to employers that their certificate holders meet a set of national standards for professionalism.
The most widely acclaimed certifying organization in the country is The National Association of Social Workers (NASW). They offer GSWs three certificate options which provide credentials specific to the field of geriatrics. Licensed social workers with bachelor’s degrees may test for the NASW’s Social Worker in Gerontology certificate if they have completed three years of supervised training and 20 hours of relevant post-grad education. GSWs with master’s degrees who have two years of experience working with the elderly may be eligible for NASW’s Advanced Social Worker in Gerontology credential or the Clinical Social Worker in Gerontology certificate.
Scholarships for Assisted Living Careers
Though getting a degree isn’t always necessary for caregivers, studies have shown that having a college education can significantly boost employer confidence in the applicant. Unfortunately, many direct care aides never seek a college degree due to high tuition and fees, and caregiving professionals who require multiple degrees, such as geriatric care managers, can run up student loan debt that takes years to pay down.
Caregiving is now a more critical and fast-growing industry than ever, and though finding scholarships to pursue higher education in these fields may be difficult, they are out there. The Caring.com scholarship guide for caregivers is a comprehensive guide to available scholarships for care providers in six high-demand careers. There, you can find information on acceptance windows and eligibility requirements for scholarship applications, as well as tips to help you put your best foot forward.