The different characteristics of the sites influence the design and operation of each of the LTC RAPs. In particular, the sites experience with training prior to creating the LTC RAP, interest in developing career ladders or better quality jobs, the size of the program, and the length of time and experience with the registered apprenticeship model may influence the characteristics of the LTC RAP.
Pre-existing intensive training programs with OJT components at Developmental Services and Home Care Associates facilitated a smooth transition to the use of the registered apprenticeship model for their training. Developmental Services simply augmented its established direct support training program, which had been operating since 1975, to meet the requirements for the DSS LTC RAP. Classroom and OJT hours have been increased since Developmental Services initiated its LTC RAP, and the curriculum for the related technical instruction has been more formalized. Home Care Associates was able to use registered apprenticeship certification as a way to distinguish between staff who had successfully completed the existing enhanced training regimen and those who had not. In transitioning its existing training model to the LTC RAP, Home Care Associates modified its enhanced training to match the HHA core competencies; OJT and mentoring received new emphasis, and a wage progression for apprentices was implemented.
The potential career ladder is emphasized at Air Force Villages, where the HSS position is a promotion for CNAs, with licensed practical nurses (LPNs) and registered nurses (RNs) as more senior positions to HSSs. There are no articulated career ladders for the DSSs at Developmental Services, the HHAs at Home Care Associates, and the CNAs at Good Samaritan and Agape. Home Care Associates emphasizes that the LTC RAP is not intended to develop a career ladder for HHAs but to create a quality job for the industry, providing stable, full-time HHA employment with benefits and where growth in skill level is rewarded through wage progression and mentor status. Agape staff suggested that while there is no specific career ladder put in place by the LTC RAP, apprentices are known and are considered to be more experienced than other CNAs by both their peers and their supervisors. Staff at Agape and Home Care Associates shared that some of the apprentices have pursued or are considering pursuing nursing degrees. In this sense, the LTC RAP offers a door to advancing the careers of the apprentices, even if it does not provide an explicit career ladder.
Nationally, LTC RAPs are relatively small in size, with a mean number of active apprentices of 37 and a median of six, as shown in Figure 1. According to data in the RAPIDS system,9 Developmental Services is the largest of the sponsors visited, with 183 active apprentices at the time of the site visit and a total of 1,150 apprentices enrolled since 2005 (Table 1). Related technical instruction at Developmental Services is conducted by one full-time medical trainer and a human resources staff person. Good Samaritan also has over 100 active apprentices (118) and has enrolled 389 apprentices since 2005. Apprentices at Good Samaritan complete most of their related technical instruction material outside of work using DVDs and workbooks. In-class training at Good Samaritan is conducted outside of work hours for both students and instructors.
Air Force Villages, Home Care Associates, and Agape sponsor smaller LTC RAPs than Developmental Services and Good Samaritan. Air Force Villages has 36 active apprentices and has enrolled 62 apprentices since it began in 2009. While initially started as an on-line course, the Air Force Villages LTC RAP now uses 7-8 managers at the facility who teach related technical instruction in 2-hour increments in-house. Agape has 38 apprentices currently enrolled, with a total of 59 apprentices over the course of its operation. Home Care Associates is the smallest of the LTC RAPs visited with eight registered apprentices at the time of the visit and 26 apprentices enrolled since it started in 2006. This sponsor has two instructors that provide all training, including related technical instruction for the LTC RAP.
Experience with or length of time operating the LTC RAP differed across sites. Developmental Services, Home Care Associates, and Good Samaritan all started their programs at least 5 years ago -- 2005, 2006, and 2003, respectively. Air Force Villages and Agape both began their programs in 2009. However, the length of the programs existence does not necessarily correlate with larger numbers of apprentices. While Developmental Services has a well-established program that trains all new workers and is the largest sponsor visited, Home Care Associates and Good Samaritan have relatively small programs even though they have been existence longer than Air Force Villages and Agape. Both Air Force Villages and Agape have plans to expand their LTC RAPs in the near term.
|FIGURE 1. Number of Registered Long-Term Care Apprentices by Site and National Mean and Median
|SOURCE: Calculations by authors, RAPIDS data on apprentices from January 2005 to May 2011.|
|TABLE 1. Characteristics of the Selected Long-Term Care Registered Apprenticeship Program Sites|
|Program Characteristics||Program Site
Home Care Associates
Air Force Villages
|Type of sponsor organizations||Private, not-for-profit direct support provider||Private, not-for-profit multi-site nursing facilities||Worker-owned, not-for-profit home health aide provider||Private, not-for-profit retirement community||Private, a combination of for-profit and not-for-profit, skilled nursing facility, Assisted Living consortium|
|Apprenticeship occupation(s)||Direct support specialist||Certified nursing assistant||Home health aide||Health support specialist||Certified nursing assistant|
|Types of services provided||Direct support for clients with developmental disabilities and group home management||Nursing home care||Home health services, primarily for the elderly and those with cognitive deficits||Independent living, skilled nursing care, assisted living, home health||Skilled nursing care, assisted living|
|Revenue sources||Medicaid, United Way, and private donations||Medicare, Medicaid, private insurance and out-of-pocket||Medicare, Medicaid, private insurance and out-of-pocket||Private insurance and out-of-pocket, CHAMPUS, Medicare,||Medicare, Medicaid, private insurance and out-of-pocket|
|Date when program established||2004||2003||2006||2009||2009|
|Number of active registered apprentices (as of May 2011)||183||118 nationally
(32 in Idaho sites visited)
|Number of apprentices (registered and those completed) currently employed||497||178||25||59||55|
|SOURCES: Data collected from Interviews at and materials from LTC RAP sites, October 2010-June 2011; and calculations by authors, RAPIDS, January 2005-May 2011.|