Recruiting caregivers like Deina Neff – let alone retaining them – is perhaps the largest challenge facing the health care industry, especially pandemic-battered nursing homes.
Some are offering signing bonuses. Most are raising wages. One Western New York nursing home even rolled out a red carpet for an on-the-spot hiring event in mid-March.
That might get a new employee in the door, but employers must work just as hard to keep them for the long term in what has become a high-turnover field. One way to do that: training programs that allow employees to advance their careers, provide better care and make more money.
For Neff, a paid training program took her from longtime certified nursing assistant to licensed practical nurse at Northgate Health Care Facility in North Tonawanda.
“I feel like I can do more for my residents to kind of advocate for them a little bit better as a nurse,” said Neff, a 33-year-old Youngstown resident with a desire to keep advancing up the ladder.
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These kinds of career ladder programs could be a major key in chipping away at the long-term care staffing crisis. As it stands, it’s been difficult for nursing homes to maintain adequate staffing due to unsupportive working conditions, a negative perception of the facilities and poor pay and benefits, according to a recent national study by the Committee on the Quality of Care in Nursing Homes. Further, the report notes, increasing nurse staffing has been a constant recommendation for improving the quality of care in nursing homes.
That’s a primary driver behind controversial laws that went into effect April 1 at New York’s more than 600 nursing homes, requiring the facilities to meet minimum staffing standards and investments.
Trade groups representing nursing homes are suing over the laws, while unions are cheering – seeing the mandates as crucial antidotes to address the chronic understaffing that has fueled labor unrest in recent months and pushed many workers to find employment elsewhere.
Long-awaited laws requiring minimum staffing standards and investments at New York’s nursing homes went into effect April 1. Labor unions and consumer advocates breathed a sigh of relief. A trade group filed a lawsuit.
That’s why these training programs, such as the one Neff completed, could be so important. They often represent a partnership involving an employer and a labor union, geared toward showing employees that there is advancement potential beyond a job that may only pay slightly above minimum wage.
Neff, whose surgical mask can’t hide her welcoming smile as she walks around Northgate, is proof that the programs can work.
The pandemic exacerbated the staffing crunch at US nursing and residential care facilities, with employment down by about 390,000 jobs, or nearly 12%, since February 2020, federal data show.
Finding nurses, especially licensed practical nurses, or LPNs, has been particularly difficult. And pandemic working conditions didn’t help in what is an aging workforce: The median age of a LPN in 2020 was 53 years old, a year older than in 2017, according to a national survey.
Data from regional trade group Iroquois Healthcare Association, which regularly surveys its members, found a job vacancy rate of 37% for long-term care LPNs in the second quarter – the highest percentage out of all job titles and up from 32% in the first quarter.
It took an average of 85 days to fill a LPN opening in a nursing home during the first quarter – a long time, for sure, but significantly less than the category-leading 157 days to find a respiratory therapist.
The McGuire Group, which owns Northgate, opted to look within: working with its current employees in training programs “so that there’s a thrust in career ladders and career development within our organization,” said Aaron Polanski, administrator of health care services for the group .
The LPN apprenticeship program that Neff participated in was the second of its kind in New York – a joint effort involving McGuire Group, labor union 1199SEIU United Healthcare Workers East, the 1199SEIU Training & Employment Funds and the Health Career Advancement Program, an organization that works with employers, unions and workers to deploy training opportunities.
The state Health Department, McGuire and others chipped in funds.
Planning began in summer 2019, with the group identifying a need for additional LPNs in the Buffalo area, said Don Fiorilli, regional director of 1199SEIU Training & Employment Funds. As those discussions began, classes for a LPN apprenticeship program that his group had developed with senior care nonprofit Loretto in Syracuse were just beginning. That gave the Buffalo group a blueprint to follow.
The next steps for the McGuire program came around October 2019, with student recruitment and academic assessment. Then in January 2020, Neff and nine other McGuire union certified nursing assistants started classes at Trocaire College – lessons that shifted to remote learning when the pandemic started.
Of the 10 participants, eight completed the 14-month program and graduated – all are still employed with McGuire.
A key to the program’s success: It allowed participants to work a reduced number of hours during their schooling but maintain their full income and benefits. Neff said she only had to pay for her books.
“A lot of people’s restraint from going back to school is they can’t afford it,” she said. “So that definitely took out a lot of that stress.”
A grant-funded program in Niagara Falls, which was created by the Niagara Falls Housing Authority in collaboration with Orleans/Niagara BOCES and Niagara Falls Memorial Medical Center, seeks to put a tooth in the staffing pinch rocking the health care system and elevate employment prospects for low-income residents with limited access to training opportunities.
Aside from the strong graduation rate, Fiorilli said he considers the program a success because it removed barriers for students and helped participants advance their skills and earnings.
A typical LPN, for instance, made $23.11 per hour last year, compared with a median hourly wage of $14.56 for nursing assistants, according to federal data.
The same Iroquois Healthcare Association study found, among all job titles, certified nursing assistants, or CNAs, in long-term care settings had the highest turnover rate last year, at about 62%. That compared with about 32% for long-term care LPNs.
“Many CNAs can make similar wages working at Amazon or Walmart,” said David Grabowski, a health care policy professor at Harvard Medical School. “A paid training LPN program is a difference-maker for both these staff and the nursing homes. Several nursing home companies and states have set up these career ladder programs but it would be great to see more widespread adoption with federal support.”
Fiorilli said Loretto and McGuire have expressed interest in doing the program again – and he believes other nursing homes also can develop successful career ladder programs.
“The program can certainly be replicated, and it can certainly be scaled,” Fiorilli said. “But investments are required.”
More programs are certainly popping up, such as a nursing assistant training initiative launched this year by the Niagara Falls Housing Authority, Orleans/Niagara BOCES and Niagara Falls Memorial Medical Center.
The program, supported by $226,000 from Highmark Blue Cross Blue Shield of Western New York’s Blue Fund, has graduated 25 students since February and more free six-week classes are being scheduled throughout the year.
While that program aims to get more nursing assistants into the market, organizers also hope to see graduates advance from CNA to beyond – just like Neff did at Northgate.
Neff is glad the LPN program came along when it did. She started at Northgate in 2013 and was a longtime CNA when the opportunity arose. The program gave her the chance to advance her career and do more for the residents she cares for.
She’s getting her feet wet as a LPN now, but she’s thinking about advancing further one day. At one point, she thought of rising to a nurse practitioner.
“Health care is a tough job, but it’s extremely fulfilling,” Neff said. “Wherever it is that you want to be in health care, you will be there – especially if you really want it.”
This story was produced through the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and universities dedicated to rigorous and compelling reporting about successful responses to social problems. The group is supported by the Solutions Journalism Network.
As it stands, it’s been difficult for nursing homes to maintain adequate staffing for several reasons, including unsupportive working conditions, a negative perception of the facilities and poor pay and benefits, according to a recent national study.
The crisis has led to a broad, high-profile push to increase wages for home care workers in New York, and, in the process, elevate the visibility of an industry that allows millions of people to avoid nursing homes and age with dignity.
State health officials held a long Covid forum in February, bringing together leaders from health care, social services and government, with the goal of shaping future policies to improve society’s overall approach to the condition.
About 61% of working family caregivers have experienced at least one work-related impact, and 10% have had to give up work entirely or retire early, according to the 2020 Caregiving in the United States report.
The coaches work as in-house social workers, helping employees with myriad issues, including food insecurity, child care and budgeting. It benefits both employee and employer.
Jon Harris can be reached at 716-849-3482 or firstname.lastname@example.org. Follow him on Twitter at @ByJonHarris.