Nursing homes can't find caregivers. Sending nursing assistants back to school could help
Invisible Army: Caregivers on the Front Line: Part of an occasional series supported by the Solutions Journalism Network
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 32-year-old Youngstown, N.Y., resident with a desire to keep advancing up the ladder.
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The situation is mirrored in countless families around New York and the nation as home care workers, who are often paid less than fast food workers and receive fewer benefits, leave the field because they can’t pay their bills. Some residents with disabilities sleep in their wheelchairs at night instead of being transferred to a bed, because they’re unsure if they’ll have an aide to get them up in the morning.
The pandemic exacerbated staffing challenges at nursing homes. Employment at U.S. nursing and residential care facilities is down by 12% since February 2020, federal data show.
Finding nurses, especially 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.
Regional trade group Iroquois Healthcare Association conducted a survey of its members this year and found a job vacancy rate of 32% for long-term care LPNs – the highest percentage out of 30 job titles. It took an average of 85 days to fill a LPN opening in a nursing home – 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, has 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.
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How the response worked
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.
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 when the pandemic started.
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Was it successful?
Of the 10 participants, eight of them 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."
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. An LPN, for instance, makes in the ballpark of $20 an hour, versus closer to $15 for a certified nursing assistant.
Can it be replicated?
More programs like this continue to pop up, as private and public officials look for innovative answers to rejuvenate a tired health care workforce.
"The program can certainly be replicated, and it can certainly be scaled," Fiorilli said. "But investments are required."
Neff is glad the program came along when it did. She started at Northgate in 2013 and was a longtime CNA when the opportunity arose. 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.
The collaborative’s first series, Invisible Army: Caregivers on the Front Lines, focuses on potential solutions to challenges facing caregivers of older adults.
Jon Harris is a reporter for The Buffalo News. Reach him at firstname.lastname@example.org
Editor's note: This story has been updated to correct the spelling of Deina Neff's first name.