A Panel on Nursing Workforce Challenges in Long-term Care - PowerPoint PPT Presentation


Title: A Panel on Nursing Workforce Challenges in Long-term Care


1
B-2 A Panel on Nursing Workforce Challenges in
Long-term Care Success in Four Ways
2
  • PANEL COMPOSED OF
  • Robert Burke, The George Washington University
  • Nancy Leveille, New York
  • Bryan E. Boeskin, New York
  • Cathy S. Sena, Florida
  • Gail Patry, Rhode Island
  • Marguerite McLaughlin, Rhode Island

3
  • DISCLAIMER
  • The Views Expressed In this Presentation Are
    Based on Past Work Experience. These Views Are
    Not to Be Considered as Representative Any
    Public, Private, Federal or State Agency.

4
Overview
  • The Need for Creative Workforce Options
  • National Level Initiatives
  • State and Local Initiatives

5
Long-Term Care Nursing Workforce Shortage
  • Key factors that must be addressed to resolve the
    LTC nursing workforce shortage
  • External factors that would increase the number
    of nurses available and interested in LTC
  • Internal factors that would decrease the turnover
    of nurses by improving the relative
    attractiveness of the LTC workplace

6
Recruitment and Retention Goals
  • Improve recruitment by increasing the number of
    nurses and aides interested in working in LTC
  • Improve the retention of nurses by re-engineering
    the LTC workplace to make it more attractive to
    the nursing workforce

7
  • Commissions Recommendations
  • State and Local Initiatives

8
State and Local Initiatives
  • Establish broad State level coordinating
    committees
  • Establish working partnerships at State level
  • Develop financial support for nursing initiatives
  • Promote metro and regional initiatives
  • Improve LTC workplace for nurses and aides by
    assisting efforts of individual facilities

9
Establish State Level Collaboration
  • With health care organizations, educational
    institutions, nursing education programs, the
    public workforce, government, and businesses and
    foundations
  • To understand the factors driving the LTC nursing
    shortage
  • To develop a comprehensive set of solutions to
    the LTC nursing shortage in the state

10
Create working partnerships
  • With individual nursing education, public
    workforce, and nursing organizations
  • To plan and implement specific programs and
    projects to improve nursing workforce  

11
Secure ongoing financial support
  • State Medicaid funds
  • State general funds that support nursing
    education
  • DoL Workforce Investment Board funds
  • Contributions by long-term care providers

12
Develop LTC nursing workforce initiatives in
individual metropolitan and regions
  • Once State level partnerships and programs are
    established, a major goal should be to initiate
    local level activities
  • Local activities will be operating programs
    involving individual ltc facilities and
    individual nursing colleges, workforce boards and
    other organizations

13
Assist individual facilities to improve their
workplace conditions
  • State organizations should actively support
    facility level initiatives to improve nursing
    workforce retention

14
Next Steps
  • Initiatives to improve LTC must be based on
  • new partnerships with the LTC community and
  • counterparts in the nursing education, workforce,
    nursing, aging, and health care communities all
    playing key roles

15
Next Steps
  • Without dedicated and persistent leadership from
    LTC leaders throughout the nation, the other
    necessary partners will not focus their attention
    in this area.
  • The leadership for LTC nursing workforce efforts
    must come from the LTC community itself.

16
Workforce Challenges
  • Increase facility competitiveness and job
    security through programs that improve incumbent
    workers skills.
  • Training that responds to the changing world
  • Affordable
  • Applicable to better paying jobs
  • Integrating workers with limited English
    proficiency
  • Coordinated combined approach with skills
    developments not an English first approach

17
Workforce Challenges
  • Respond to small and medium size facilities (less
    than 500 employees) recruitment and training
    needs.
  • Demand Driven and multi-employer
  • Tied to regional economic development
  • Meeting employer demand while minimizing effects
    of layoffs
  • Effective and fast job matching

18
Workforce Challenges
  • Assuring a pipeline of skilled workers
  • Training for higher paid classifications
  • Recognized credential
  • Continuing a pipeline of young workers
  • Connected to public schools
  • Evidence that the program works to get high
    school graduates to enter the field.

19
Nursing Homes are Major Source of Jobs
2005 2015
Nurse Staff Vacancies 96,000 450,000
Total Expenditures 120 Billion 215 Billion
20
American health care is 4.1 billion dollar
industry, 16 of the DNP
  • Currently, there are 96,000 full-time vacancies
    in nursing homes estimated 434,000 in 2010.
  • 216,000 more positions due to retirement and
    turnover.
  • During the period between 2010 and 2025,
    long-term care jobs will be created at a rate of
    almost six times the rate of overall labor force
    growth.

21
New York Develops Successful Local Partnerships
  • Presented by
  • Nancy Leveille and
  • Bryan E. Boeskin

22
  • Introduction/Overview
  • LTC Workforce Needs/Challenges
  • Workforce Strategies being used in New York
  • Building and Sustaining Workforce Partnerships
  • Examples of Successful Workforce Projects in NY
  • Finding and Securing Workforce Funding
  • Next Steps
  • Resources

23
LTC Workforce Needs/Challenges
  • Pipeline of new nurses entering LTC
  • Reduced turnover and higher retention rates
  • Pathways for advancement
  • Structured training for nurse leadership
  • Fill gap of nurse leadership training at academic
    institutions

24
LTC Workforce Needs/Challenges
  • Minimize competition between healthcare settings
  • Aging out of the nursing profession in LTC
  • Career Development programs that are
  • Flexibly scheduled
  • Affordable
  • Provide Accreditation
  • Driven by needs of the workplace

25
Strategies to Address Needs
  • Programs assist in recruitment
  • Programs assist in improving retention
  • Introducing and engaging members with the
    workforce investment system
  • Engagement with educational institutions and DOH
  • Aggressive pursuit of funding to support
    workforce programs

26
Building and Sustaining
Workforce Partnerships
  • Skilled Nursing Facilities
  • State and Regional Workforce Investment Boards
    (WIBs)
  • Educational Institutions
  • Healthcare Trade Associations
  • Professional Associations
  • State Government
  • Federal Government
  • Private Foundations

27
Successful Workforce Projects
  • LTC Leadership Institute
  • Day of LTC Education Project
  • Health Care Career Fairs
  • Engagement with Workforce System
  • Scholarship Programs

28
LTC Leadership Institute
  • Goals Provide paths to advancement, improve
    staff retention, better prepared workforce
  • Method Provide leadership education that is
    accredited, accessible and affordable to LTC
    professionals
  • Partners MECF,SUNYIT, NYSNA, SNFs, Employees,
    DOH, DOL, HRSA
  • Outcomes Train up to 850 LTC Leaders between
    2002-2010
  • Impacts Paths to advancement, improved
    retention, replicable model for other areas,
    improved quality of care

29
Day of LTC Education Project
  • Goals Connect nursing educators, nursing
    students and LTC Providers to promote the merits
    of careers in LTC and recruit new employees
  • Methods LTC Day of Education on SUNYIT campus
    with special guest speaker and opportunities for
    direct interface and exchange between LTC
    providers, nursing faculty and students
  • Partners MECF, SUNYIT, NYSNA, Area SNFs, Nursing
    Students
  • Outcomes Recruit new nursing students to in LTC.
    Faculty and career counselors promoting
    opportunities in LTC.
  • Impacts Increased applicant pool of well
    qualified nurses interested in working in LTC .

30
Health Care Career Fairs
Goals Recruit new health care employees by
directly connecting LTC Employers with qualified
jobseekers in their region. Methods Regional .5
Day Career Fair that is specifically geared to
health care providers and health care
professionals and paraprofessionals. Partners
Workforce NY, Regional WIBs, SNFs, Educational
Training Institutions, Healthcare Associations,
jobseekers Outcomes 2005-2006 participation
from more than 80 Health Care employers and
nearly 500 jobseekers in the Capital Region of
NY. Impacts Recruitment of new LTC employees
to pursue careers in LTC facilities in the
region. Preparing to replicate program in other
areas of the state.
31
Engagement with Workforce System
Goals LTC health care as a top priority for
State/ Regional WIBS. LTC providers understand
and access workforce programs and
services. Methods Connect members directly with
WIBs. Represent LTC on WIBs. Apply for workforce
funds. Partners AHCA, MECF, DOL, Workforce NY,
Regional WIBs, SNFs, Outcomes Members serving
on WIBs. Relationships between WIBs and SNFs.
Members have applied and secured WIB funds.
Impacts LTC sector is being recognized as a
priority for workforce funding at the state and
regional level. LTC providers are more fully
engaging with workforce investment system.
32
Scholarship Programs
Goals To provide higher educational
opportunities for incumbent LTC employees. To
offer opportunities for employee advancement, and
ultimately improve staff retention. Methods
Award annual scholarships for 2 LPNs and 2 RNs
working in LTC. Partners SNFs, Nurses employed
in SNFs, Individual contributors Outcomes
Granted approximately 40 nurse scholarships since
1997 Impacts Increased pool of LPNs, RNs.
Pathways to career advancement.
33
Workforce Funding
  • Funding Sources for Healthcare Workforce
  • Federal DOL, HRSA (see www.grants.gov)
  • State DOH, DOL/Workforce System
  • Private Sources
  • Community Foundations
  • Family Foundations
  • Traditional Fundraising

34
Next Steps
  • Geriatric Nursing Assistant Career Development
    Program
  • Career Ladder Education Program for CNAs
  • Pathways Healthcare Professions
  • Working with middle and high schools to promote
    interest in LTC careers

35
Resources
  • US Dept. of Labor- Employment and training
    Administration (www.doleta.gov)
  • US Health Resources and Services Administration
    (www.hrsa.gov)
  • www.grants.gov
  • The Center for Health Workforce Studies, School
    of Public Health, SUNY Albany (www.chws.albany.edu
    )
  • State DOH, DOL
  • AHCA
  • NYSHFA/FQC and other State Associations

36
  • Connecticut Develops Successful Local
    Partnerships
  • Presented by
  • Robert Burke, GWU
  • Prepared by
  • Marian Eichner and Marie Spivey
  • Capital Workforce Partners

37
  • Lead Agency
  • Capitol Workforce Partners (CWP) The COO of the
    CWP is the Principle Investigator and a senior
    nurse and is the proposed Project Manager to
    oversee the day to day operations.

38
  • Partnerships
  • Four North Central Regional Community Colleges
  • Eight Long Term Care Facilities
  • 1,199 Training and Upgrading Fund
  • CT Association of Health Care Facilities

39
  • Partnerships
  • CT Association of Non-Profit Providers for the
    Aging
  • CT Office for Workforce Competitiveness
  • Capitol Region Education Council
  • Vernon Adult Education

40
  • Training - As specified by ETA
  • Enhanced C.N.A. and LPN Training
  • Diversity/ESOL Training
  • Cultural and Linguistic Competency Training
  • Incumbent CNA Training

41
  • OUTCOMES
  • 646 Incumbents in 10 LTC Facilities
  • 431 CNA- Skills to Quality for Wage Increase
  • 72 CNA- Core College Work

42
SHOW ME THE MONEY
  • Florida Develops Successful
  • Local Partnerships
  • Presented by
  • Cathy Sena

43
Community Providers LTC Partnership Model
Developed by AHCA
44
South Florida LTC Nursing Investment (TRELLIS)
Project Partners
  • Access to DOL via South Florida Workforce
    Investment Board funding streams (TIMTOWTDI)
  • Florida Health Care Association (CNA II
    curriculum development)
  • American Health Care Association George
    Washington University (technical support)

45
South Florida LTC Nursing Investment (TRELLIS)
Project Partners
  • Long Term Care Providers/Employers in Miami-Dade
    (CNAs, clinical and training sites)
  • Miami Dade College of Nursing (classrooms,
    instructors, course development assistance and
    customized education across LTC spectrum)
  • Miami Dade County Public Schools (classrooms,
    instructors)

46
Your Local Workforce Investment Board a Key
Partner
  • CORE MANDATES Match Employers with Qualified
    Job Seekers and Train the Workforce to Meet
    Employer Needs
  • EMPLOYER SERVICES
  • Self-Service Hiring
  • Full-Service Hiring
  • Tax Incentives
  • Labor Market Information
  • Training Programs

47
Your Local Workforce Investment Board a Key
Partner
  • TRAINING PROGRAMS
  • On-the-Job Training
  • Individual Training Accounts (ITAs)
  • Incumbent Worker Training
  • Quick Response Training
  • Customized Training

48
Customized Training
  • Hire-first agreement
  • Recoup up to 50 of training costs for career
    mobility initiatives tied to wage increases
  • Reimbursements apply to programs at approved
    educational institutions and Train the Trainer
    programs
  • Up to 50,000 per project without board approval

49
WIBs Also Offer
  • Pre-screening of employee candidates
  • Career Fairs with Healthcare Employers
  • Work Experience Job Shadowing for Youth
  • Life Skills Career Readiness - confidence,
    skills enhancement, ESOL, soft skills competency,
    etc.
  • One Stop Career Centers

50
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • FHCA has developed a 40 hour CNA II advancement
    track course beyond the current test prep course.
    Seven Modules include
  • Restorative/Rehabilitative Activities
  • Restorative Activities, Falls Prevention,
    Restraints
  • Nutrition Dining
  • Nutrition Diet, Dining Best Practices

51
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • Comfort Care, Palliative Pain Management
  • Understanding Death Dying, Providing Comfort
    Care for Dying Residents, Religious Spiritual
    Factors
  • Dementia Care
  • Understanding Dementia, Behavioral Problems
    Management
  • Mentoring/Leadership/Communication Skills
  • Problem Solving Conflict Resolution, Team
    Building Communication, Supervisory Skills,
    Motivating, Rewarding Evaluating, Customer
    Services, Cultural Diversity

52
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • Understanding the Nursing Home Survey Process
    Developing Changes
  • Focus on the role of the direct care giver and
    residents choices
  • Emphasis on dignity and cultural change through
    the residents eyes
  • Managing Clinical Acuity and Risk Factors
  • Aging Process, Pressure Ulcers, Monitoring
    Evaluating, Communication Reporting, Other risk
    factors

53
MIAMI-DADE COLLEGESchool of Community Education
  • Will provide customized courses for employees
    even develop specialized ones that have been
    identified
  • A qualified instructor will work with
    participants at the skill level requested
  • Courses include Nursing Skills Update LPN
    Intravenous Therapy, Spanish, English, Medical
    Terminology, Bookkeeping, Human Resources
    Professional, Food Manager Certificate among
    others

54
The Florida TRELLIS Concept
  • Training for Retention Empowerment through
    Ladders Lattices for Innovative Sustainability
  • Through Key Partnerships with FHCA, South Florida
    Workforce Local Education Providers, We are
    Creating a Sustainable Framework for Career
    Mobility Opportunities in LTC
  • Nursing Career Path including CNA I, CNA II,
    LPN
  • Supervisory and Coaching Classes
  • ESOL classes vocational language proficiency
  • Classes for Administrators, RNs and other
    employees within a long term care facility
    (Customized Training by MDC)

55
Current Status of Project
  • Transitioning our GOALS to REALITY in SoFla
  • Assessing workforce needs at facilities
  • 2 Pilot facilities in process of workforce grant
    applications
  • FHCA CNA Advanced Track Curriculum integration
    (ASAP)
  • February 08 Consortium of facilities will
    apply
  • The OBJECTIVE
  • Improved Quality Stability in the LTC Workforce
    Arena
  • Transportability

56
The Southlake Project
57
Our WIN-WIN Deal!
  • Identified entry level workers in dietary and
    housekeeping that were good CNA candidates
  • Use of WorkSource (Jax WIB) funds for
    transitioning entry level staff to CNA level with
    opportunity for wage increases
  • 3 weeks intensive didactic and clinical training
    once they pass the exam, the newly certified CNA
    continues for 6 additional weeks under the
    mentorship and supervision of a CNA team leader
    to master clinical skills

58
RESULTS!!!
  • 13 of 16 NAs passed the CNA challenge exam on
    the first try through our program this past year.
  • Entry level vacancies filled through WorkSource
    (Jacksonville Regional WIB) pipeline.
  • We foster a learning environment that results in
    advancement of skill sets and employee
    satisfaction. With employee retention being
    paramount to our ultimate goal of providing
    quality care, investing in our employees is a
    WIN-WIN.

59
OTHER STRATEGIC PARTNERSHIPS
  • Participate in Career Days at your local
    elementary, middle high schools. Children have
    an idea as early as 4th grade what they want to
    do when they grow up.
  • Create partnerships with local schools for
    Community Service hours help create
    opportunities for them to bond with the elderly
    and consider a career in LTC.
  • Consider membership in NAHCA a professional
    organization for frontline caregivers which
    provides life long learning, employee benefits
    and more.
  • Sensible Immigration Legislation Be a
    legislative advocate!

60
Rhode Island Develops Successful Local
Partnerships
  • Presented by
  • Gail Patry and
  • Marguerite McLaughlin

61
Background
  • LTC Sector is a primary source of entry-level
    employment
  • New and incumbent workers face significant
    obstacles low wages, juggling multiple jobs, and
    lack of time to commit to training to earn
    higher wages
  • Goal of Industry Partnerships is to transfer LTC
    employment from lacking opportunity for
    advancement to a gateway of opportunity!

62
Mission and Goals
  • Mission To create better job opportunities and
    provide better quality of care for RIs elders
  • Goals
  • Stabilize the workforce,
  • Improve the workplace culture, and
  • Maximize use of public workforce development
    resources by LTC employers

63
Objectives
  • Objectives
  • Skills Gap Study
  • Curriculum Development
  • Implementation and Evaluation

64
Strategic Partnership
  • BF Consulting
  • CareLink
  • CommCorp
  • Governors Workforce Board RI
  • Dept. of Labor and Training (RI)
  • Quality Partners of Rhode Island
  • RI Nursing Home Providers

65
Partners Experience and Expertise
  • Quality Improvement
  • Systems Redesign
  • Individualized Care
  • Transformational Change
  • Building career pathways within the industry

66
Partners Experience and Expertise
  • Ability to offer learning and resources to help
    shape the RI initiative
  • Ability to apply quality improvement principles
    to workforce retention strategies in a way that
    leads to significant improvements in retention
    and in clinical and organizational quality for
    NHs.

67
Work Completed to Date
  1. Formalized Partnership
  2. Skills Gap Study
  3. Career Ladder Curriculum Development

68
1. Formalized Partnership
  • Formalized in October 2006 clarified
    deliverables, secured dates, assigned
    responsibilities, and began recruitment
  • Regular meetings scheduled
  • Partners recognized the potential to include
    other interested partners and to identify other
    funding streams to compliment or expand this work

69
2. Skills Gap Study
  • To examine and report on the needs and critical
    workforce issues causing a crisis in RI
  • To inform the development of the career ladder
    curriculum
  • RESULTS confirmed skill shortages and
    difficulties encountered by employers and
    employees in LTC, as well as a broadening gap
    between the availability of skilled workers and
    the employee performance within nursing homes

70
3. Career Ladder Curriculum Development
  • Researched available curriculum models
  • In April 2007, firm decisions about the
    curriculum were made model development and topic
    selections were made
  • Currently, the partners are organizing and
    writing the curriculum.

71
Barrier To Implementation
  • Barrier The partners were able to immediately
    identify the needs of the NHs as they relate to
    training. What they learned was how unrealistic
    it is to take staff off the floor to attend
    training, even if only for a short time, since
    short staffing is a major contributor to the
    workforce crisis.

72
Solution to Barrier
  • Solution To pursue a new style of training and
    education for NH employeestaking a systems
    approach - that would ignite the LTC industry by
    creating a catalyst for change and growth.

73
Outcomes to Date Pollination Education
  • A creative response to the difficulty and
    challenges NHs face to deliver necessary and
    valuable education to staff.
  • Its focus on adult education principles,
    work-based learning on the floor of a nursing
    home, mentoring, and on-line support will create
    an intrinsic sense of teamwork and camaraderie in
    learning.
  • Learning Bee Activities move practical knowledge
    into practice, affecting the lives of residents,
    co-workers, and families alike.

74
Next Steps
  • The curriculum evaluation plan will be finalized
    during summer 2007.
  • The goal was to begin implementing the curriculum
    in August 2007
  • Participant NHs felt that the timeline would not
    be effective during summer months due to short
    staffing and vacations. They requested it be
    delivered in September 2007.

75
Next Steps
  • The GWBRI granted a change in contract
    deliverable dates (from summer 2007 to September
    2007) for both implementation and evaluation of
    the career ladder curriculum

76
Additional Funding Streams
  • US Department of Labors ETA Workforce
    Innovation in Regional Economic Development
    (WIRED) Initiative (approximately 5,000,000)
  • Robert Wood Johnson Foundation Jobs To Careers
    grant (437,750)

77
Additional Funding Streams
  • US Department of Labors Employment and Training
    Administration (ETA) High Growth Job Training
    Initiative for the Long Term Care Sector
    (500,000)
  • Rhode Island Department of Educations Office of
    Adult Education Call for Investments
    (January 26, 2007) (249,522)

78
Additional Partners
  • Rhode Island Health Care Association
  • Rhode Island Association of Facilities and
    Services for the Aging
  • RI Dept. of Education
  • RI Dept. of Health
  • Community College of RI
  • University of Rhode Island
  • Health Partnership Council
  • Dorcas Place
  • The Genesis Center

79
For More Information
  • Panel Coordinator
  • Robert Burke, GWU (202)416-0492
  • bobburke_at_gwu.edu
  • New York
  • Nancy Leveille, NYSHFA. (518) 462-4800
  • nleveille_at_nyshfa.org
  • Bryan E. Boeskin, (518) 462-4800 ext. 34
  • bboeskin_at_foundationforqualitycare.org
  • Foundation for Quality Care
  • Connecticut
  • Marian Eichner,   860-522-1111
  • Marie Spivey,  
  • Capital Workforce Partners
  • Florida
  • Cathy S. Sena, (305) 759-4046
  • Florida Health Care Association,
  • and Mandarin Health Group
  • CatSena_at_aol.com
  • Rhode Island
  • Gail Patry, (401) 528-3200
  • gpatry_at_riqiosdps.org
  • Marguerite McLaughlin (401) 528-3200
  • Mmclaughlin_at_ripiosdps.org
  • Melissa Miranda (401) 528-3200
  • Mmiranda_at_riqio.sdps.org
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A Panel on Nursing Workforce Challenges in Long-term Care

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Title: A Panel on Nursing Workforce Challenges in Long-term Care


1
B-2 A Panel on Nursing Workforce Challenges in
Long-term Care Success in Four Ways
2
  • PANEL COMPOSED OF
  • Robert Burke, The George Washington University
  • Nancy Leveille, New York
  • Bryan E. Boeskin, New York
  • Cathy S. Sena, Florida
  • Gail Patry, Rhode Island
  • Marguerite McLaughlin, Rhode Island

3
  • DISCLAIMER
  • The Views Expressed In this Presentation Are
    Based on Past Work Experience. These Views Are
    Not to Be Considered as Representative Any
    Public, Private, Federal or State Agency.

4
Overview
  • The Need for Creative Workforce Options
  • National Level Initiatives
  • State and Local Initiatives

5
Long-Term Care Nursing Workforce Shortage
  • Key factors that must be addressed to resolve the
    LTC nursing workforce shortage
  • External factors that would increase the number
    of nurses available and interested in LTC
  • Internal factors that would decrease the turnover
    of nurses by improving the relative
    attractiveness of the LTC workplace

6
Recruitment and Retention Goals
  • Improve recruitment by increasing the number of
    nurses and aides interested in working in LTC
  • Improve the retention of nurses by re-engineering
    the LTC workplace to make it more attractive to
    the nursing workforce

7
  • Commissions Recommendations
  • State and Local Initiatives

8
State and Local Initiatives
  • Establish broad State level coordinating
    committees
  • Establish working partnerships at State level
  • Develop financial support for nursing initiatives
  • Promote metro and regional initiatives
  • Improve LTC workplace for nurses and aides by
    assisting efforts of individual facilities

9
Establish State Level Collaboration
  • With health care organizations, educational
    institutions, nursing education programs, the
    public workforce, government, and businesses and
    foundations
  • To understand the factors driving the LTC nursing
    shortage
  • To develop a comprehensive set of solutions to
    the LTC nursing shortage in the state

10
Create working partnerships
  • With individual nursing education, public
    workforce, and nursing organizations
  • To plan and implement specific programs and
    projects to improve nursing workforce  

11
Secure ongoing financial support
  • State Medicaid funds
  • State general funds that support nursing
    education
  • DoL Workforce Investment Board funds
  • Contributions by long-term care providers

12
Develop LTC nursing workforce initiatives in
individual metropolitan and regions
  • Once State level partnerships and programs are
    established, a major goal should be to initiate
    local level activities
  • Local activities will be operating programs
    involving individual ltc facilities and
    individual nursing colleges, workforce boards and
    other organizations

13
Assist individual facilities to improve their
workplace conditions
  • State organizations should actively support
    facility level initiatives to improve nursing
    workforce retention

14
Next Steps
  • Initiatives to improve LTC must be based on
  • new partnerships with the LTC community and
  • counterparts in the nursing education, workforce,
    nursing, aging, and health care communities all
    playing key roles

15
Next Steps
  • Without dedicated and persistent leadership from
    LTC leaders throughout the nation, the other
    necessary partners will not focus their attention
    in this area.
  • The leadership for LTC nursing workforce efforts
    must come from the LTC community itself.

16
Workforce Challenges
  • Increase facility competitiveness and job
    security through programs that improve incumbent
    workers skills.
  • Training that responds to the changing world
  • Affordable
  • Applicable to better paying jobs
  • Integrating workers with limited English
    proficiency
  • Coordinated combined approach with skills
    developments not an English first approach

17
Workforce Challenges
  • Respond to small and medium size facilities (less
    than 500 employees) recruitment and training
    needs.
  • Demand Driven and multi-employer
  • Tied to regional economic development
  • Meeting employer demand while minimizing effects
    of layoffs
  • Effective and fast job matching

18
Workforce Challenges
  • Assuring a pipeline of skilled workers
  • Training for higher paid classifications
  • Recognized credential
  • Continuing a pipeline of young workers
  • Connected to public schools
  • Evidence that the program works to get high
    school graduates to enter the field.

19
Nursing Homes are Major Source of Jobs
2005 2015
Nurse Staff Vacancies 96,000 450,000
Total Expenditures 120 Billion 215 Billion
20
American health care is 4.1 billion dollar
industry, 16 of the DNP
  • Currently, there are 96,000 full-time vacancies
    in nursing homes estimated 434,000 in 2010.
  • 216,000 more positions due to retirement and
    turnover.
  • During the period between 2010 and 2025,
    long-term care jobs will be created at a rate of
    almost six times the rate of overall labor force
    growth.

21
New York Develops Successful Local Partnerships
  • Presented by
  • Nancy Leveille and
  • Bryan E. Boeskin

22
  • Introduction/Overview
  • LTC Workforce Needs/Challenges
  • Workforce Strategies being used in New York
  • Building and Sustaining Workforce Partnerships
  • Examples of Successful Workforce Projects in NY
  • Finding and Securing Workforce Funding
  • Next Steps
  • Resources

23
LTC Workforce Needs/Challenges
  • Pipeline of new nurses entering LTC
  • Reduced turnover and higher retention rates
  • Pathways for advancement
  • Structured training for nurse leadership
  • Fill gap of nurse leadership training at academic
    institutions

24
LTC Workforce Needs/Challenges
  • Minimize competition between healthcare settings
  • Aging out of the nursing profession in LTC
  • Career Development programs that are
  • Flexibly scheduled
  • Affordable
  • Provide Accreditation
  • Driven by needs of the workplace

25
Strategies to Address Needs
  • Programs assist in recruitment
  • Programs assist in improving retention
  • Introducing and engaging members with the
    workforce investment system
  • Engagement with educational institutions and DOH
  • Aggressive pursuit of funding to support
    workforce programs

26
Building and Sustaining
Workforce Partnerships
  • Skilled Nursing Facilities
  • State and Regional Workforce Investment Boards
    (WIBs)
  • Educational Institutions
  • Healthcare Trade Associations
  • Professional Associations
  • State Government
  • Federal Government
  • Private Foundations

27
Successful Workforce Projects
  • LTC Leadership Institute
  • Day of LTC Education Project
  • Health Care Career Fairs
  • Engagement with Workforce System
  • Scholarship Programs

28
LTC Leadership Institute
  • Goals Provide paths to advancement, improve
    staff retention, better prepared workforce
  • Method Provide leadership education that is
    accredited, accessible and affordable to LTC
    professionals
  • Partners MECF,SUNYIT, NYSNA, SNFs, Employees,
    DOH, DOL, HRSA
  • Outcomes Train up to 850 LTC Leaders between
    2002-2010
  • Impacts Paths to advancement, improved
    retention, replicable model for other areas,
    improved quality of care

29
Day of LTC Education Project
  • Goals Connect nursing educators, nursing
    students and LTC Providers to promote the merits
    of careers in LTC and recruit new employees
  • Methods LTC Day of Education on SUNYIT campus
    with special guest speaker and opportunities for
    direct interface and exchange between LTC
    providers, nursing faculty and students
  • Partners MECF, SUNYIT, NYSNA, Area SNFs, Nursing
    Students
  • Outcomes Recruit new nursing students to in LTC.
    Faculty and career counselors promoting
    opportunities in LTC.
  • Impacts Increased applicant pool of well
    qualified nurses interested in working in LTC .

30
Health Care Career Fairs
Goals Recruit new health care employees by
directly connecting LTC Employers with qualified
jobseekers in their region. Methods Regional .5
Day Career Fair that is specifically geared to
health care providers and health care
professionals and paraprofessionals. Partners
Workforce NY, Regional WIBs, SNFs, Educational
Training Institutions, Healthcare Associations,
jobseekers Outcomes 2005-2006 participation
from more than 80 Health Care employers and
nearly 500 jobseekers in the Capital Region of
NY. Impacts Recruitment of new LTC employees
to pursue careers in LTC facilities in the
region. Preparing to replicate program in other
areas of the state.
31
Engagement with Workforce System
Goals LTC health care as a top priority for
State/ Regional WIBS. LTC providers understand
and access workforce programs and
services. Methods Connect members directly with
WIBs. Represent LTC on WIBs. Apply for workforce
funds. Partners AHCA, MECF, DOL, Workforce NY,
Regional WIBs, SNFs, Outcomes Members serving
on WIBs. Relationships between WIBs and SNFs.
Members have applied and secured WIB funds.
Impacts LTC sector is being recognized as a
priority for workforce funding at the state and
regional level. LTC providers are more fully
engaging with workforce investment system.
32
Scholarship Programs
Goals To provide higher educational
opportunities for incumbent LTC employees. To
offer opportunities for employee advancement, and
ultimately improve staff retention. Methods
Award annual scholarships for 2 LPNs and 2 RNs
working in LTC. Partners SNFs, Nurses employed
in SNFs, Individual contributors Outcomes
Granted approximately 40 nurse scholarships since
1997 Impacts Increased pool of LPNs, RNs.
Pathways to career advancement.
33
Workforce Funding
  • Funding Sources for Healthcare Workforce
  • Federal DOL, HRSA (see www.grants.gov)
  • State DOH, DOL/Workforce System
  • Private Sources
  • Community Foundations
  • Family Foundations
  • Traditional Fundraising

34
Next Steps
  • Geriatric Nursing Assistant Career Development
    Program
  • Career Ladder Education Program for CNAs
  • Pathways Healthcare Professions
  • Working with middle and high schools to promote
    interest in LTC careers

35
Resources
  • US Dept. of Labor- Employment and training
    Administration (www.doleta.gov)
  • US Health Resources and Services Administration
    (www.hrsa.gov)
  • www.grants.gov
  • The Center for Health Workforce Studies, School
    of Public Health, SUNY Albany (www.chws.albany.edu
    )
  • State DOH, DOL
  • AHCA
  • NYSHFA/FQC and other State Associations

36
  • Connecticut Develops Successful Local
    Partnerships
  • Presented by
  • Robert Burke, GWU
  • Prepared by
  • Marian Eichner and Marie Spivey
  • Capital Workforce Partners

37
  • Lead Agency
  • Capitol Workforce Partners (CWP) The COO of the
    CWP is the Principle Investigator and a senior
    nurse and is the proposed Project Manager to
    oversee the day to day operations.

38
  • Partnerships
  • Four North Central Regional Community Colleges
  • Eight Long Term Care Facilities
  • 1,199 Training and Upgrading Fund
  • CT Association of Health Care Facilities

39
  • Partnerships
  • CT Association of Non-Profit Providers for the
    Aging
  • CT Office for Workforce Competitiveness
  • Capitol Region Education Council
  • Vernon Adult Education

40
  • Training - As specified by ETA
  • Enhanced C.N.A. and LPN Training
  • Diversity/ESOL Training
  • Cultural and Linguistic Competency Training
  • Incumbent CNA Training

41
  • OUTCOMES
  • 646 Incumbents in 10 LTC Facilities
  • 431 CNA- Skills to Quality for Wage Increase
  • 72 CNA- Core College Work

42
SHOW ME THE MONEY
  • Florida Develops Successful
  • Local Partnerships
  • Presented by
  • Cathy Sena

43
Community Providers LTC Partnership Model
Developed by AHCA
44
South Florida LTC Nursing Investment (TRELLIS)
Project Partners
  • Access to DOL via South Florida Workforce
    Investment Board funding streams (TIMTOWTDI)
  • Florida Health Care Association (CNA II
    curriculum development)
  • American Health Care Association George
    Washington University (technical support)

45
South Florida LTC Nursing Investment (TRELLIS)
Project Partners
  • Long Term Care Providers/Employers in Miami-Dade
    (CNAs, clinical and training sites)
  • Miami Dade College of Nursing (classrooms,
    instructors, course development assistance and
    customized education across LTC spectrum)
  • Miami Dade County Public Schools (classrooms,
    instructors)

46
Your Local Workforce Investment Board a Key
Partner
  • CORE MANDATES Match Employers with Qualified
    Job Seekers and Train the Workforce to Meet
    Employer Needs
  • EMPLOYER SERVICES
  • Self-Service Hiring
  • Full-Service Hiring
  • Tax Incentives
  • Labor Market Information
  • Training Programs

47
Your Local Workforce Investment Board a Key
Partner
  • TRAINING PROGRAMS
  • On-the-Job Training
  • Individual Training Accounts (ITAs)
  • Incumbent Worker Training
  • Quick Response Training
  • Customized Training

48
Customized Training
  • Hire-first agreement
  • Recoup up to 50 of training costs for career
    mobility initiatives tied to wage increases
  • Reimbursements apply to programs at approved
    educational institutions and Train the Trainer
    programs
  • Up to 50,000 per project without board approval

49
WIBs Also Offer
  • Pre-screening of employee candidates
  • Career Fairs with Healthcare Employers
  • Work Experience Job Shadowing for Youth
  • Life Skills Career Readiness - confidence,
    skills enhancement, ESOL, soft skills competency,
    etc.
  • One Stop Career Centers

50
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • FHCA has developed a 40 hour CNA II advancement
    track course beyond the current test prep course.
    Seven Modules include
  • Restorative/Rehabilitative Activities
  • Restorative Activities, Falls Prevention,
    Restraints
  • Nutrition Dining
  • Nutrition Diet, Dining Best Practices

51
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • Comfort Care, Palliative Pain Management
  • Understanding Death Dying, Providing Comfort
    Care for Dying Residents, Religious Spiritual
    Factors
  • Dementia Care
  • Understanding Dementia, Behavioral Problems
    Management
  • Mentoring/Leadership/Communication Skills
  • Problem Solving Conflict Resolution, Team
    Building Communication, Supervisory Skills,
    Motivating, Rewarding Evaluating, Customer
    Services, Cultural Diversity

52
Advanced CNA Curriculum of the Florida TRELLIS
Project
  • Understanding the Nursing Home Survey Process
    Developing Changes
  • Focus on the role of the direct care giver and
    residents choices
  • Emphasis on dignity and cultural change through
    the residents eyes
  • Managing Clinical Acuity and Risk Factors
  • Aging Process, Pressure Ulcers, Monitoring
    Evaluating, Communication Reporting, Other risk
    factors

53
MIAMI-DADE COLLEGESchool of Community Education
  • Will provide customized courses for employees
    even develop specialized ones that have been
    identified
  • A qualified instructor will work with
    participants at the skill level requested
  • Courses include Nursing Skills Update LPN
    Intravenous Therapy, Spanish, English, Medical
    Terminology, Bookkeeping, Human Resources
    Professional, Food Manager Certificate among
    others

54
The Florida TRELLIS Concept
  • Training for Retention Empowerment through
    Ladders Lattices for Innovative Sustainability
  • Through Key Partnerships with FHCA, South Florida
    Workforce Local Education Providers, We are
    Creating a Sustainable Framework for Career
    Mobility Opportunities in LTC
  • Nursing Career Path including CNA I, CNA II,
    LPN
  • Supervisory and Coaching Classes
  • ESOL classes vocational language proficiency
  • Classes for Administrators, RNs and other
    employees within a long term care facility
    (Customized Training by MDC)

55
Current Status of Project
  • Transitioning our GOALS to REALITY in SoFla
  • Assessing workforce needs at facilities
  • 2 Pilot facilities in process of workforce grant
    applications
  • FHCA CNA Advanced Track Curriculum integration
    (ASAP)
  • February 08 Consortium of facilities will
    apply
  • The OBJECTIVE
  • Improved Quality Stability in the LTC Workforce
    Arena
  • Transportability

56
The Southlake Project
57
Our WIN-WIN Deal!
  • Identified entry level workers in dietary and
    housekeeping that were good CNA candidates
  • Use of WorkSource (Jax WIB) funds for
    transitioning entry level staff to CNA level with
    opportunity for wage increases
  • 3 weeks intensive didactic and clinical training
    once they pass the exam, the newly certified CNA
    continues for 6 additional weeks under the
    mentorship and supervision of a CNA team leader
    to master clinical skills

58
RESULTS!!!
  • 13 of 16 NAs passed the CNA challenge exam on
    the first try through our program this past year.
  • Entry level vacancies filled through WorkSource
    (Jacksonville Regional WIB) pipeline.
  • We foster a learning environment that results in
    advancement of skill sets and employee
    satisfaction. With employee retention being
    paramount to our ultimate goal of providing
    quality care, investing in our employees is a
    WIN-WIN.

59
OTHER STRATEGIC PARTNERSHIPS
  • Participate in Career Days at your local
    elementary, middle high schools. Children have
    an idea as early as 4th grade what they want to
    do when they grow up.
  • Create partnerships with local schools for
    Community Service hours help create
    opportunities for them to bond with the elderly
    and consider a career in LTC.
  • Consider membership in NAHCA a professional
    organization for frontline caregivers which
    provides life long learning, employee benefits
    and more.
  • Sensible Immigration Legislation Be a
    legislative advocate!

60
Rhode Island Develops Successful Local
Partnerships
  • Presented by
  • Gail Patry and
  • Marguerite McLaughlin

61
Background
  • LTC Sector is a primary source of entry-level
    employment
  • New and incumbent workers face significant
    obstacles low wages, juggling multiple jobs, and
    lack of time to commit to training to earn
    higher wages
  • Goal of Industry Partnerships is to transfer LTC
    employment from lacking opportunity for
    advancement to a gateway of opportunity!

62
Mission and Goals
  • Mission To create better job opportunities and
    provide better quality of care for RIs elders
  • Goals
  • Stabilize the workforce,
  • Improve the workplace culture, and
  • Maximize use of public workforce development
    resources by LTC employers

63
Objectives
  • Objectives
  • Skills Gap Study
  • Curriculum Development
  • Implementation and Evaluation

64
Strategic Partnership
  • BF Consulting
  • CareLink
  • CommCorp
  • Governors Workforce Board RI
  • Dept. of Labor and Training (RI)
  • Quality Partners of Rhode Island
  • RI Nursing Home Providers

65
Partners Experience and Expertise
  • Quality Improvement
  • Systems Redesign
  • Individualized Care
  • Transformational Change
  • Building career pathways within the industry

66
Partners Experience and Expertise
  • Ability to offer learning and resources to help
    shape the RI initiative
  • Ability to apply quality improvement principles
    to workforce retention strategies in a way that
    leads to significant improvements in retention
    and in clinical and organizational quality for
    NHs.

67
Work Completed to Date
  1. Formalized Partnership
  2. Skills Gap Study
  3. Career Ladder Curriculum Development

68
1. Formalized Partnership
  • Formalized in October 2006 clarified
    deliverables, secured dates, assigned
    responsibilities, and began recruitment
  • Regular meetings scheduled
  • Partners recognized the potential to include
    other interested partners and to identify other
    funding streams to compliment or expand this work

69
2. Skills Gap Study
  • To examine and report on the needs and critical
    workforce issues causing a crisis in RI
  • To inform the development of the career ladder
    curriculum
  • RESULTS confirmed skill shortages and
    difficulties encountered by employers and
    employees in LTC, as well as a broadening gap
    between the availability of skilled workers and
    the employee performance within nursing homes

70
3. Career Ladder Curriculum Development
  • Researched available curriculum models
  • In April 2007, firm decisions about the
    curriculum were made model development and topic
    selections were made
  • Currently, the partners are organizing and
    writing the curriculum.

71
Barrier To Implementation
  • Barrier The partners were able to immediately
    identify the needs of the NHs as they relate to
    training. What they learned was how unrealistic
    it is to take staff off the floor to attend
    training, even if only for a short time, since
    short staffing is a major contributor to the
    workforce crisis.

72
Solution to Barrier
  • Solution To pursue a new style of training and
    education for NH employeestaking a systems
    approach - that would ignite the LTC industry by
    creating a catalyst for change and growth.

73
Outcomes to Date Pollination Education
  • A creative response to the difficulty and
    challenges NHs face to deliver necessary and
    valuable education to staff.
  • Its focus on adult education principles,
    work-based learning on the floor of a nursing
    home, mentoring, and on-line support will create
    an intrinsic sense of teamwork and camaraderie in
    learning.
  • Learning Bee Activities move practical knowledge
    into practice, affecting the lives of residents,
    co-workers, and families alike.

74
Next Steps
  • The curriculum evaluation plan will be finalized
    during summer 2007.
  • The goal was to begin implementing the curriculum
    in August 2007
  • Participant NHs felt that the timeline would not
    be effective during summer months due to short
    staffing and vacations. They requested it be
    delivered in September 2007.

75
Next Steps
  • The GWBRI granted a change in contract
    deliverable dates (from summer 2007 to September
    2007) for both implementation and evaluation of
    the career ladder curriculum

76
Additional Funding Streams
  • US Department of Labors ETA Workforce
    Innovation in Regional Economic Development
    (WIRED) Initiative (approximately 5,000,000)
  • Robert Wood Johnson Foundation Jobs To Careers
    grant (437,750)

77
Additional Funding Streams
  • US Department of Labors Employment and Training
    Administration (ETA) High Growth Job Training
    Initiative for the Long Term Care Sector
    (500,000)
  • Rhode Island Department of Educations Office of
    Adult Education Call for Investments
    (January 26, 2007) (249,522)

78
Additional Partners
  • Rhode Island Health Care Association
  • Rhode Island Association of Facilities and
    Services for the Aging
  • RI Dept. of Education
  • RI Dept. of Health
  • Community College of RI
  • University of Rhode Island
  • Health Partnership Council
  • Dorcas Place
  • The Genesis Center

79
For More Information
  • Panel Coordinator
  • Robert Burke, GWU (202)416-0492
  • bobburke_at_gwu.edu
  • New York
  • Nancy Leveille, NYSHFA. (518) 462-4800
  • nleveille_at_nyshfa.org
  • Bryan E. Boeskin, (518) 462-4800 ext. 34
  • bboeskin_at_foundationforqualitycare.org
  • Foundation for Quality Care
  • Connecticut
  • Marian Eichner,   860-522-1111
  • Marie Spivey,  
  • Capital Workforce Partners
  • Florida
  • Cathy S. Sena, (305) 759-4046
  • Florida Health Care Association,
  • and Mandarin Health Group
  • CatSena_at_aol.com
  • Rhode Island
  • Gail Patry, (401) 528-3200
  • gpatry_at_riqiosdps.org
  • Marguerite McLaughlin (401) 528-3200
  • Mmclaughlin_at_ripiosdps.org
  • Melissa Miranda (401) 528-3200
  • Mmiranda_at_riqio.sdps.org
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