May 2009

Grant Results

National Program

New Jersey Health Initiatives Program

SUMMARY

From 2003 to 2007, the Somerset County Training Consortium—which includes two visiting nurse associations, two home-health-aide agencies, four assisted living facilities, one English as a Second Language (ESL) provider and three long-term-care facilities in Somerset County, N.J.—conducted a training course aimed at expanding the number of certified home-health aides and certified nurse assistants available to provide direct care in home, assisted living and nursing home settings. The consortium also aimed to improve job retention and job satisfaction among these workers.

The Community Visiting Nurse Association of Bridgewater, N.J., the home health agency that initiated negotiations leading to the training consortium, was the lead agency in this project.

Key Results

  • Some 87 percent of enrollees completed the training, compared with 50 percent typical of other training programs for such paraprofessionals.
  • All trainees were eligible to take state certification exams, and their pass rate was above 90 percent. Some 99 percent of those who took the home-health-aide exam passed. Some 94 percent of those who took the long-term-care exam passed, compared with a statewide pass rate of 70 percent.
  • Some 81 percent of 43 trainees for whom data were available remained employed a year after graduating from the program. This 19 percent one-year attrition rate improves on the 40 to 60 percent three-month attrition rate reported by participating agencies before the project began.

Funding
As part of its New Jersey Health Initiatives, RWJF supported this project with a grant of $210,149.

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THE PROBLEM

The demand for direct-care workers in homes, nursing homes and other community-based long-term-care settings is growing rapidly as the U.S. population ages and the number of people with disabilities rises.

According to the U.S. Bureau of Labor Statistics, by 2010 the nation will need more than 780,000 additional aides to fill long-term-care positions—an increase of 39 percent over the year 2000. However, during the same 10-year period, the traditional source of such workers—the population of women aged 25 to 44—is projected to grow by just 400,000, or 1.25 percent.

In 2003, the Community Visiting Nurse Association, a home health agency in Bridgewater, N.J., brought together home health and long-term-care providers in Somerset County to explore solutions to predicted workforce shortages. The group that formed as a result—the Somerset County Training Consortium—aimed to pool resources to provide training for potential employees.

Agencies typically train the home-health aides they hire, at the agencies' expense. Certified nurse assistants—who work in nursing homes and other institutions—typically pay for their own training at local colleges, and the organization that hires them then reimburses them. However, consortium members agreed that training and reimbursing applicants individually was becoming infeasible because of:

  • Difficulties with recruiting new staff.
  • Financial constraints among the agencies as well as the certified nurse assistant trainees, who often cannot afford to pay up-front tuition costs.
  • Lack of knowledge among agencies and trainers about using English as a Second Language (ESL) techniques in teaching the many foreign-speaking students.
  • A shortage of trainers.
  • Individual agencies being unable to attain large-enough class size to be economically feasible.

Joint training by consortium members, especially if backed by a strong ESL component, could address these challenges.

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RWJF STRATEGY

RWJF has supported a large number of projects and programs in the area of long-term care. Much information can be found through the RWJF home page for long-term care.

Grant Results Topic Summaries on RWJF-funded projects and programs cover the following topics:

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THE PROJECT

Under this grant, each member of the Somerset County Training Consortium—which came to include 11 health providers and one ESL educator within Somerset County—recruited and sponsored individuals for the joint training. The agencies also contributed staff members to teach a portion of each four-to-six-week course. They used a curriculum developed in 2001 by the New Jersey Board of Nursing to train home-health and long-term-care aides together.

To overcome language barriers, the consortium partnered with another community-based organization—the Jointure for Community Adult Education—to cross-train ESL and health care instructors in the curriculum and ESL. Jointure ESL staff rewrote the curriculum to simplify language and add more visuals and hands-on learning activities. They also taught alongside the health care instructors.

Students received free training and a stipend, and could participate in monthly support groups and request one-on-one coaching to further address language or learning problems. After completing the course and passing a state certification exam, trainees could begin working for their sponsoring agency.

To determine how effectively the course met its goals, the project team looked at rates of enrollment, competence (based on the number of trainees who passed state boards) and job placement and retention. Project staff also mailed a survey to graduates to measure their job satisfaction after six months. (See the Bibliography for details.)

Communications

The project team made three presentations at state-sponsored meetings designed to showcase innovative solutions to challenges regarding the health care workforce.

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RESULTS

The project director reported the following results to RWJF:

  • A total of 149 individuals enrolled in 12 four-to-six-week training courses during the three-year project period. Four of the sessions focused on ESL trainees, who accounted for 40 percent of all enrollees. One "Gap" session was held for four students who were already certified as long-term-care aides and only needed a 10 hour program to become certified as home-health aides. The regular class size ranged from 10 to 15 students per session, with an average of 12.
  • A total of 129 individuals, or 87 percent, completed the training, compared with the 50 percent typical of other training programs for these paraprofessionals. Attrition was higher for ESL students (24 percent) than non-ESL students (7 percent). Of the graduating trainees:
    • 45 percent (58) were Black, with slightly more than half of these foreign born.
    • 29 percent (37) were Hispanic.
    • 18 percent (24) were White.
    • 8 percent (10) were Asian.
  • All trainees were eligible to take state certification exams, and their pass rate was above 90 percent. Some 99 percent of those who took the home-health-aide exam passed. Some 94 percent of those who took the long-term-care exam passed, compared with a statewide pass rate of 70 percent.
  • Member agencies hired 96.2 percent of eligible graduates, while the remaining 3.8 percent chose to find employment elsewhere.
  • Some 81 percent of 43 trainees for whom data were available remained employed a year after graduating from the program. This 19 percent annual attrition rate improves on the 40 to 60 percent three-month attrition rate reported by participating agencies before the project began.

    Some 88 percent of graduates from the first course who responded to the job satisfaction survey reported being very satisfied or satisfied with their job, while just 4 percent were dissatisfied or very dissatisfied.

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LESSONS LEARNED

  • Provide an ESL component when training home-health aides and certified nurse assistants. By including such a component, the project expanded the pool of potential trainees, and many formerly excluded individuals enrolled in the program. (Project Director/Brophy)
  • Tailor such training to communicate more effectively with ESL students and with non-ESL students with literacy issues. In this project, instructors tried to become more culturally sensitive and changed their teaching styles to accommodate such students, such as by explaining concepts more carefully, offering more practice sessions and clinical demonstrations and giving shorter and more frequent tests.

    The result was more active classroom participation, improved test-taking skills and greater confidence among ESL students. (Project Director/Brophy)
  • Training home-health aides and long-term-care aides together strengthened both programs resulting in better prepared more confident students. (Project Director/Brophy)

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AFTER THE GRANT

Eight organizations in the training consortium plan to conduct another course in the spring of 2009. In lieu of outside funding, which the consortium continues to seek, the agencies expect to self-finance the program.

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GRANT DETAILS & CONTACT INFORMATION

Project

Collaboration for paraprofessional training, literacy and job success

Grantee

Valley Health Care Corp. dba Community Visiting Nurse Association (Bridgewater,  NJ)

  • Amount: $ 210,149
    Dates: October 2003 to April 2007
    ID#:  049610

Contact

Alyce Brophy
(908) 725-9355
alyce@communityvna.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Survey Instruments

"Home Health/Hospice/Long Term Care/Assisted Living Employee Satisfaction Survey," Community Visiting Nurse Association, fielded 2004–2007.

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Report prepared by: Robert Crum
Reviewed by: Sandra Hackman
Reviewed by: Molly McKaughan
Program Officer: Pamela S. Dickson

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