A geriatric nursing assistant (GNA) is a certified nursing assistant with specialized training in caring for elderly patients, primarily in long-term care facilities like nursing homes. The role builds on a standard CNA foundation by adding focused education on the needs of aging adults, including help with daily activities, monitoring health changes, and providing personal care under the supervision of licensed nurses.
How a GNA Differs From a CNA
Every GNA starts as a certified nursing assistant. The “geriatric” designation adds a layer of training specific to older adult care. In practice, GNAs work almost exclusively in long-term care settings (nursing homes, skilled nursing facilities), while CNAs may work in hospitals, clinics, or surgical centers where the patient population is broader.
The distinction is not nationally standardized. Whether “GNA” exists as a formal credential depends on your state. Maryland, for example, has maintained a separate GNA certification that requires completing an approved GNA course on top of CNA certification, then passing a geriatric-specific exam. But even Maryland is phasing this out: effective April 2026, the separate GNA designation will be removed. Current CNA/GNA holders will become “CNA-I” (eligible to work in long-term care), while standard CNAs will become “CNA-II” (not eligible for long-term care). Other states fold geriatric training into general CNA programs or leave it to individual employers.
What a GNA Does Day to Day
GNAs handle the hands-on, daily care that keeps residents comfortable and safe. Their work centers on what healthcare professionals call activities of daily living: bathing, dressing, grooming, feeding, and helping patients get to the bathroom. These tasks sound simple, but doing them well for elderly patients with limited mobility, fragile skin, or cognitive decline requires real skill and patience.
Beyond personal care, GNAs take vital signs like blood pressure and temperature, help patients move around safely (transferring from bed to wheelchair, walking down hallways), assist with oral hygiene and nail care, change bed linens, and maintain basic infection control practices. Some GNAs also administer medications, depending on state regulations and their facility’s policies. They document changes in a patient’s condition and report concerns to the nurses supervising their floor.
Communication and compassion rank among the most important skills employers look for. GNAs often spend more one-on-one time with residents than any other staff member, which means they’re frequently the first to notice a change in appetite, mood, or physical ability that signals a larger health problem.
Where GNAs Work
Nursing homes and long-term care facilities employ the majority of GNAs, but the role extends to assisted living facilities, home healthcare services, hospice programs, and hospitals with dedicated geriatric units. The common thread is an older patient population that needs regular, ongoing assistance rather than acute medical intervention.
Training and Certification Requirements
Federal law, established by the Omnibus Budget Reconciliation Act of 1987, requires every nursing assistant working in a Medicare- or Medicaid-certified facility to complete at least 75 hours of approved training and pass a competency evaluation. States can (and often do) require more hours than this federal minimum. The training must be supervised by a registered nurse with at least two years of nursing experience, including one year in long-term care.
In states with a formal GNA credential, you typically complete a CNA program first, then enroll in an additional geriatric-focused course covering topics like age-related conditions, fall prevention, dementia care, and end-of-life support. After finishing the coursework, you sit for a GNA-specific exam. In Maryland, GNAs must also verify at least 8 hours of work in a long-term care facility within the two years before renewing their certification.
Where no separate GNA credential exists, employers may provide their own geriatric training during orientation or require continuing education credits focused on elder care.
Pay and Job Prospects
The Bureau of Labor Statistics groups GNAs with the broader nursing assistant category. As of May 2024, the median annual wage for nursing assistants was $39,530, which works out to roughly $18.96 per hour. The lowest 10 percent earned under $31,390, while the top 10 percent earned more than $50,140. Pay varies significantly by state, metro area, and facility type.
Demand for nursing assistants in geriatric settings remains strong. The aging U.S. population continues to drive growth in long-term care, and turnover in these roles is historically high, meaning job openings are consistently available. For someone looking to enter healthcare quickly without a four-year degree, GNA work offers a practical entry point with opportunities to advance into licensed practical nursing or registered nursing programs down the line.
Skills That Set Strong GNAs Apart
Technical competence matters, but experienced GNAs will tell you the job is as much emotional as physical. Residents in long-term care facilities are often dealing with chronic pain, progressive memory loss, or the grief of losing independence. A GNA who can maintain dignity during intimate care tasks, stay calm during a confused patient’s outburst, and genuinely connect with someone who may have few other visitors provides something no clinical protocol can replicate.
Physically, the work is demanding. Lifting and repositioning patients, spending entire shifts on your feet, and responding quickly to falls or emergencies are all part of a normal day. Infection control knowledge is essential, especially in facilities where residents are vulnerable to illness. Employers also value basic record-keeping skills, since accurate documentation of a patient’s food intake, mobility, and behavioral changes directly informs the care plan nurses and physicians use to make treatment decisions.