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

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

5. 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 Long-Term Care Nursing Workforce Shortage

6. Improve recruitment byincreasing 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 attractiveto the nursing workforce Recruitment and Retention Goals

7. Commission’s Recommendations State and Local Initiatives

8. 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 State and Local Initiatives

9. 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 Establish State Level Collaboration

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

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

12. 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 Develop LTC nursing workforce initiatives in individual metropolitan and regions

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

14. 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 Next Steps

15. 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. Next Steps

16. 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 Workforce Challenges

17. 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 Workforce Challenges

18. 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. Workforce Challenges

19. Nursing Homes are Major Source of Jobs

20. 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. American health care is $ 4.1 billion dollar industry, 16% of the DNP

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. 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 LTC Workforce Needs/Challenges

24. 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 LTC Workforce Needs/Challenges

25. 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 Strategies to Address Needs

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

28. 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 LTC Leadership Institute

29. 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 . Day of LTC Education Project

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. 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 Workforce Funding

34. 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 Next Steps

35. 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 Resources

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 $$$ viaSouth Florida WorkforceInvestment 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(CNA’s, 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 (ITA’s) Incumbent Worker Training Quick Response Training Customized Training *

48. 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 Customized Training*

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