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Pay Check.

Contemporary's 1999 nursing and administrative salary survey

Reduced reimbursement coupled with increased regulatory scrutiny in the nursing home business. Greater competition in the assisted living sector. These developments make one thing perfectly clear: Long term care employees, from administrators to nursing assistants, are under unprecedented pressure to perform. In a perfect world, compensation would rise with the challenges. But contemporary's 1999 administrative and nursing salary survey reveals only a slight increase in pay for management types like admins and DONs, and virtually no increase for direct-care employees.

And industry representatives, consultants, recruiters, and others are not happy about it.

Karen Tucker, president and CEO of the American College of Health Care Administrators, thinks admin salaries-which our survey shows to be in the mid-fifties-are woefully inadequate given the "complexities of the role and the ever-increasing demands."

Tucker also notes that salaries are significantly lower than that of hospital administrators "but the demands are greater and the job more complex given regulations and licensure requirements."

But Ken Cohen, president of Synergy Organization, a Bensalem, Pennsylvania, executive search firm, sees things changing. "Organizations are becoming increasingly interested in hiring the right person and understand that it may cost them a little more, but that, ultimately, they'll save a lot of money.

"It's becoming more of a seller's market for good admins because a good one is hard to find," continues Cohen. "A lot of organizations want someone who can raise quality of care, improve cost efficiencies, help to market services, and handle a lot of internal issues. They're raising the bar in terms of the standards they're setting, and you can't do that without raising the caliber of the people you bring in."

DONs also are getting more respect. "An executive director told me the DON should get paid more than the administrator because she really controls the pulse of the organization--the quality of a facility is defined by its nursing care," says Cohen.

DONs who have worked with prospective payment are commanding higher salaries. "Our clients want PPS experience and are willing to pay more for it," says Steffani Lane, vice president of Management Recruiters of Scottsdale, Arizona.

Lane also notes that PPS-related pressures are making it more of a seller's market. "Turnover is at an all-time high. It's hard to get good people and money can be a motivating factor. Also, employees are offering to stay if they get more money."

Susanne Matthiesen, program director for the Wertleib Educational Institute for Long Term Care Management at George Washington University, has also observed that "nurses who are more familiar with MDS have the upper hand in negotiating salary because they have a skill that's in demand." Matthiesen also notes that graduating students seem to be "making a little bit more in assisted living, in CCRCs, and in the northeast region. I've also heard that Alzheimer's facilities pay better." However, she adds, "We haven't noticed any major changes in the benefits area--we'd love to see more tuition benefits."

Assisted living providers also pay for administrative experience, although their definition of experience ranges more widely. "Some people in assisted living will only look at someone with assisted living background," says Lane, "Others will consider someone with a nursing background, a hospitality background, or just someone with strong managerial skills who can deal with people."

Experience with Alzheimer's care is also a good bargaining chip, says Lane. "I have clients that focus on Alzheimer's and are looking for people with that expertise, and they're fewer and farther between than the run-of-the-mill admin."

If so, front-line employees with Alzheimer's experience are not sharing in the bounty. "We've done focus groups with CNAs and the low pay is and continues to be a concern" says Marlene Mahn, residential care specialist at the Alzheimer's Association.

In the assisted living industry, increased competition, especially in smaller markets, could lead to escalation in labor costs, notes Raymond James analyst James Kumpel. But only to a point. "Because the rural assisted living model is premised on low cost and low revenues per bed, if labor costs start spiraling out of control, effectively that model is shot."

Some states have raised Medicaid rates in order to increase salaries. One is Minnesota. Darrell Shreve, director of research and regulations for Minnesota Health and Housing Alliance, the Minnesota affiliate of AAHSA, says last year 23 percent of its member facilities stopped admitting residents because they didn't have the staff to take care of . them--and they didn't have the staff because they couldn't keep them at the prevailing wages. Medicaid came through with an increase in rates, the lion's share of which will go to providing better wages and benefits to nursing staff, where the greatest shortages are, says Shreve.


Survey forms were sent to a representative sample, drawn from Contemporary's readership database, of 3,009 administrators at facilities that provide skilled nursing and/or assisted living care. It yielded a response rate of 13.4 percent. Of these 398 responses, 365 were usable.

Respondents who listed themselves as either administrator or executive director were counted as administrators. Those whose facilities provide more than one type of care were grouped according to their primary responsibility.

The salaries listed under "nursing" are for freestanding nursing facilities only. Overall averages include respondents who work in hospital-based SNFs as well.

The results were tabulated by Philadelphia-based Hamlyn Senior Marketing.
 The national average
Average wages for all administrative and nursing staff, irrespective of
facility type.

 In thousands
 Administrator $55,081
Assistant administrator $33,970
 DON $46,387
 Assistant DON $38,416
 Dollars per hour
 RN supervisor $17.36
 Charge nurse $15.12
 Case manager $17.03
 LPN $12.70
Nursing assistant $7.51

The national average by sector

Assisted living facilities pay administrators better than nursing facilities do, but salaries for nursing staff are less generous, reflecting their lesser responsibilities. When it comes to LPNs and nursing assistants, there's little difference in salary among the sectors.
 Nursing Assisted living
 In thousands
 Administrator $59,031 $42,423
Assistant administrator $37,765 $25,964
 DON $47,598 $37,040
 Assistant DON $38,687 $33,345

Return of the raise

In 1997, 21 percent of the admins and 24 percent of DONs who responded to our survey got no raises. In 1998, that number dropped to 17 percent for administrators and plummeted to 8 percent for DONs.
4-5% raise (27%)
1-3% raise (34%)
No raise (17%)
No response (7%)
Over 10% raise (3%)
8-10% raise (5%)
6-7% raise (7%)
4-5% raise (28%)
1-3% raise (32%)
No raise (8%)
No response (20%)
Over 8% raise (3%)
6-7% raise (5%)

Bed counts count

If you're an administrator or an assistant administrator, a DON or an Assistant DON, the more beds under your command, the more you are compensated. Facility size doesn't seem to be a factor for other nursing positions, however.

Job title 1-49 50-99 100-199 200+
Administrator $43,167 $54,377 $61,443 $79,950
Asst. admin N/A $34,074 $36,464 $45,164
DON $39,770 $45,133 $49,036 $57,553
Asst. DON $32,841 $36,105 $39,569 $44,649
Case manager $15.00 $16.00 $18.00 $18.00
RN supervisor $16.00 $17.00 $17.00 $19.00
Charge nurse $16.00 $15.00 $15.00 $17.00
LPN $13.00 $12.00 $13.00 $14.00
Nursing assistant $7.00 $7.00 $8.00 $8.00
 Assisted living

Job title 1-49 50-99 100-199 200+
Administrator $32,106 546,376 $54,400 $68,850
Asst. admin $18,434 $26,500 $30,483 $72,000
DON $28,075 $41,333 $37,278 $48,750
Asst. DON $22,720 $30,250 $34,288 $38,522
Case manager $12.00 $16.00 $16.00 $20.00
RN supervisor $15.00 $16.00 $16.00 $17.00
Charge nurse $12.00 $13.00 $15.00 $13.00
LPN $11.00 $14.00 $13.00 $13.00
Nursing assistant $7.00 $7.00 $7.00 $8.00


The chart shows the percentage of administrators who received each of the listed benefits in 1998. Five percent more had 401(k) plans or received bonuses for meeting annual budget goals than did in the prior year. But 5 percent fewer reported receiving pension plans in 1998 than in 1997.
Health care insurance 86%
401(k) plan 55%
Disability insurance 50%
Bonus meeting annual budget 36%
Pension plan 30%
Life insurance 3%
Dental insurance 2%
403B 2%
Company car 2%

Administrator experience

On average, the upside salary-wise is better in nursing than in assisted living when it comes to years of experience.
Years of Assisted
experience Nursing living
1-5 $49,383 $35,948
6-10 $60,576 $42,954
11-15 $58,093 $44,929
16-20 $58,427 $42,756
More than 20 $65,567 $48,581

Rupees by region

West Coast numbers were higher than those from the Northeast in most job categories, and the South Atlantic was, again, one of the top three regions.
 North South South
Job title Northeast West Central Central Atlantic
Administrator $61,450 $65,046 $54,777 $60,153 $62,200
Asst. admin $40,064 $29,100 $39,067 $31,700 $42,800
DON $49,091 $54,449 $43,857 $46,469 $51,715
Asst. DON $42,356 $44,666 $36,102 $36,889 $41,129
Case manager $18.00 $19.00 $17.00 $15.00 $16.00
RN supervisor $18.00 $19.00 $16.00 $18.00 $18.00
Charge nurse $16.00 $17.00 $15.00 $13.00 $16.00
LPN $13.00 $14.00 $12.00 $11.00 $13.00
Nursing assistant $8.00 $8.00 $8.00 $7.00
Assisted living
Administrator $35,690 $43,087 $44,184 $35,871 $46,901
Asst. admin $30,837 $25,780 $13,500 $20,125 $27,464
DON $30,426 $35,250 $37,862 $23,750 $42,818
Asst. DON N/A $31,612 $38,840 $15,400 $35,522
Case manager $15.00 N/A $17.00 N/A N/A
RN supervisor $14.00 $16.00 $17.00 N/A $16.00
Charge nurse $15.00 $12.00 $12.00 N/A $14.00
LPN $12.00 $11.00 $12.00 $13.00 $13.00
Nursing assistant $7.00 $8.00 $7.00 $7.00 $7.00
 Revenue roundup
 Gross revenues are the best predictors of salary.

 Under $599k - $2m -
Job title $500k $1.9M $3.9m $4m+
Administrator $36,780 $47,106 $55,682 $69,639
Asst. admin $23,013 $30,080 $40,968 $39,712
DON $40,071 $40,078 $46,151 $52,839
Asst. DON $33,751 $34,074 $38,128 $40,990
Case manager $16.00 $14.62 $17.04 $17.23
RN Supervisor $16.62 $16.09 $17.41 $17.76
Charge nurse $13.31 $13.96 $15.32 $15.55
LPN $12.18 $12.16 $12.57 $13.09
Nursing assistant $7.07 $7.18 $7.55 $7.78

Chain versus independent

Assisted living chains pay their admins better than the mom-and-pops do. But in most cases, whether you work for a chain or an independent operator makes no difference.
 Nursing Assisted living
Job title Chain Indie Chain Indie
Administrator $59,983 $58,684 $49,795 $40,140
Asst. admin $38,095 $37,618 $28,450 $25,379
DON $49,254 $46,651 $36,300 $39,225
Asst. DON $40,197 $37,210 $29,335 $36,018
Case mgr. $18.00 $16.00 $16.00 $16.00
RN supervisor $18.00 $17.00 $15.00 $16.00
Charge nurse $15.00 $15.00 $13.00 $14.00
LPN $13.00 $13.00 $12.00 $12.00
Nursing asst. $8.00 $8.00 $7.00 $7.00

Admin gender gap

If you're an administrator, whether you work for a nursing facility or an assisted living community, you'll make between $15,000. and $20,00 more on average if you're a man.
 Male admin Female admin
Standalone nursing $71,320 $53,852
Assisted living $57,625 $37,800

Lucre by location

It's pretty much of a horse race between urban and suburban locales when it comes to salary, but rural facilities pay considerably less until you hit nursing assistants.
Job title Urban Suburban Rural
Administrator $64,778 $65,343 $52,614
Asst. admin $37,250 $42,345 $34,241
DON $52,657 $52,779 $42,603
Asst. DON $43,027 $42,123 $34,429
Case manager $19.00 $19.00 $14.00
BN supervisor $19.00 $19.00 $16.00
Charge nurse $17.00 $17.00 $14.00
LPN $14.00 $14.00 $12.00
Nursing asst. $8.00 $8.00 $7.00
Assisted living
Administrator $47,091 $43,211 $32,955
Asst. admin $27,793 $28,686 $20,350
DON $41,600 $34,765 $32,426
Asst. DON $43,667 $32,521 $8,000
Case manager $14.00 $14.00 $18.00
RN supervisor $16.00 $16.00 $15.00
Charge nurse $15.00 $13.00 $11.00
LPN $14.00 $12.00 $12.00
Nursing asst. $7.00 $7.00 $7.00
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Article Details
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Title Annotation:nursing salary
Publication:Contemporary Long Term Care
Article Type:Polling Data
Geographic Code:1USA
Date:Jul 1, 1999
Previous Article:THE WELLNESS MODEL.
Next Article:Proceed with caution.

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