A Panel on Nursing Workforce Challenges in Long-term Care

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B-2 A Panel on Nursing Workforce Challenges in
Long-term Care Success in Four Ways
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• 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

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• 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.

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Overview

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

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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

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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

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• Commissions Recommendations
• State and Local Initiatives

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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

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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

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Create working partnerships

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

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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

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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

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Assist individual facilities to improve their
workplace conditions

• State organizations should actively support
  facility level initiatives to improve nursing
  workforce retention

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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

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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.

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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

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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

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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.

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Nursing Homes are Major Source of Jobs
2005 2015
Nurse Staff Vacancies 96,000 450,000
Total Expenditures 120 Billion 215 Billion
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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.

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New York Develops Successful Local Partnerships

• Presented by
• Nancy Leveille and
• Bryan E. Boeskin

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• 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

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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

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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

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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

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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

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Successful Workforce Projects

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

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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

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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 .

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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.
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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.
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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.
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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

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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

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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

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

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• 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.

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

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

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

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

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SHOW ME THE MONEY

• Florida Develops Successful
• Local Partnerships
• Presented by
• Cathy Sena

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Community Providers LTC Partnership Model
Developed by AHCA
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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)

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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The Southlake Project
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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

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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.

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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!

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Rhode Island Develops Successful Local
Partnerships

• Presented by
• Gail Patry and
• Marguerite McLaughlin

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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!

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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

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Objectives

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

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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

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Partners Experience and Expertise

• Quality Improvement
• Systems Redesign
• Individualized Care
• Transformational Change
• Building career pathways within the industry

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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.

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Work Completed to Date

1. Formalized Partnership
2. Skills Gap Study
3. Career Ladder Curriculum Development

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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

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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

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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.

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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.

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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.

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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.

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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.

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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

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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)

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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)

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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

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For More Information

• Panel Coordinator
• Robert Burke, GWU [phone]
• bobburke_at_gwu.edu
• New York
• Nancy Leveille, NYSHFA. [phone]
• nleveille_at_nyshfa.org
• Bryan E. Boeskin, [phone] 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, [phone]
• Florida Health Care Association,
• and Mandarin Health Group
• CatSena_at_aol.com
• Rhode Island
• Gail Patry, [phone]
• gpatry_at_riqiosdps.org
• Marguerite McLaughlin [phone]
• Mmclaughlin_at_ripiosdps.org
• Melissa Miranda [phone]
• Mmiranda_at_riqio.sdps.org