Four of the five sites visited (Developmental Services, Good Samaritan, Air Force Villages, and Agape) are considered a hybrid registered apprenticeship model of competency-based and time-based requirements for completion of their LTC RAPs. This means that completion of the apprenticeship requirements is tracked by successfully demonstrating proficiency in each competency training associated with the occupation and by spending a specific amount of time on each competency training (see Appendix A for a detailed listing of the competency trainings by occupation). At Agape, the checklist for assuring mastery of competencies on-the-job was developed at the same time that the curriculum for the related technical instruction was developed, and therefore closely reflects the classroom material.
Home Care Associates LTC RAP is considered time-based, in which apprentices are required to spend a designated amount of time mastering each competency training. Four of the sponsors programs (Developmental Services, Good Samaritan, Home Care Associates, and Agape) are designed around participation in related technical instruction and OJT and have longer program durations, with the expectation that apprentices must demonstrate proficiencies on-the-job in the core competencies. All of the programs require substantially more training hours than, for example, the minimum 75 hours required for CNAs under federal regulation 42 CFR 483.152 to improve quality of care and workforce skills.
As shown in Table 4, the program with the most time requirements is Air Force Villages, which requires 232 hours of related technical instruction and 3,000 hours of OJT (3,232 total hours). For its HHA apprentices, Home Care Associates requires slightly more related technical instruction hours (230 hours) but fewer OJT hours (1,795 hours) for completion (2,025 total hours). Developmental Services requires 216 hours of related technical instruction, and 2,784 hours of OJT, for a total of 3,000 program hours. Good Samaritan requires that its apprentices spend 180 hours in related technical instruction and between 1,500-2,000 hours in OJT. Agape requires 265.5 hours of related technical instruction and 2,000 hours of OJT, although these hours are designed for apprentices without basic CNA certification. All Agape apprentices so far have entered the program as CNAs, and have therefore been credited hours associated with the basic CNA training and experience. These CNAs are required to attend 143.5 hours of related instruction and 1,700 hours of OJT, for a total of 1,843.5 hours. DOL allows LTC RAPs to accept past experience in the field as OJT hours. At Air Force Villages, up to 2,000 hours are credited to the apprentices for past experience. Since all Air Force Villages apprentices are CNAs, they have already received basic long-term care training and their performance on-the-job is evaluated as a CNA.
Each LTC RAP requires its apprentices to participate in OJT, which allows apprentices to practice skills and demonstrate proficiency in the core competencies. As discussed, apprentices at all sites must spend a significant amount of time in OJT (1,500-3,000 hours). While the amount of time spent in OJT varies from week to week, apprentices at these sites typically spend 40 hours per week, depending on their work schedule, in OJT (see Table 5).
Air Force Villages apprentices spend about 8 hours per week in related technical instruction when provided at the beginning of the apprenticeship. Four hours of related technical instruction is outside the classroom with management or experienced apprentices providing hands-on instruction related to classroom knowledge so that apprentices practice their newly-acquired skills. Apprentices complete a self-administered skills checklist during OJT. In addition, throughout the entire apprenticeship period, an apprentices work is monitored through the facilitys routine quality assurance protocols for all staff. If apprentices work is found to be less than satisfactory, remedial instruction focused on the skill requiring improvement is provided. Apprentices thereby gain additional time to practice the art of caregiving. For example, if during a routine quality assurance check the food is not served at the right temperature, the food services manager or dietician would provide remedial instruction to an apprentice to improve food preparation skills.
Table 5 shows that few resources other than supervisory time are used for the OJT component of the LTC RAPs, according to the sites. In the sites visited, OJT is monitored by supervisors or nurses, who are responsible for overseeing the apprentices progress. However, the degree of monitoring varies by site because of the work setting. It is easier to provide more consistent monitoring of the apprentices at Developmental Services, Good Samaritan, and Agape because workers in residential settings are more visible to supervisors. Individual home settings make it more difficult to monitor apprentices at Home Care Associates, who often work alone. Home Care Associates staff reported that supervisors and mentors spend time with the apprentices at clients homes on occasion to monitor their progress and assist in mastering a competency.
Related technical instruction in the LTC RAPs visited is divided between basic and enhanced training at Developmental Services and Home Care Associates, and is presented in a series of modules at Good Samaritan, Air Force Villages, and Agape. For each program, related technical instruction covers material from multiple core competencies approved by DOL (Table 6). (Details on these core competency trainings are provided in Appendix B.) All sites teach common competency training, such as training in medical care administration and communications skills, while other training is occupation-specific. For example, Developmental Services requires training in non-violent conflict intervention (a skill with little import in Air Force Villages retirement community), while Air Force Villages, Home Care Associates, and Agapes curriculum includes dementia training for its apprentices, skills that may not be needed in serving Developmental Services younger clientele. The palliative care specialty taught at Agape was also added because of a special interest that Agapes executives had in palliative care as hospice is a major service provided by the organization.
Related technical instruction is administered by trainers at Developmental Services, Home Care Associates, Air Force Villages, and Agape while it is self-administered by apprentices with CDs and workbooks at Good Samaritan. Air Force Villages began the program by teaching its related technical instruction on-line through a community college sponsored course rather than in a traditional classroom. Later, it switched to an in-house classroom instruction model. Time spent in related technical instruction per week varies for Good Samaritan apprentices because it is self-administered. Air Force Villages apprentices receive about 4 hours per week of related technical instruction. Agape apprentices spend 3 hours in related technical instruction every Thursday for a year. Developmental Services and Home Care Associates apprentices spend more of their time in related technical instruction at the beginning of their employment (basic training) but more advanced related technical instruction is provided at regular intervals.
Only Developmental Services pays for all costs associated with related technical instruction while Home Care Associates receives support from grants to operate its related technical instruction. Agape received grant support for training from its local workforce investment board for its first cohort of apprentices and from South Carolinas Department of Employment and Workforce for its second cohort. The third and largest cohort of Agape apprentices is being supported entirely by Agapes own funds. Air Force Villages previously received a DOL grant for related technical instruction but now has staff trainers from its management staff who conduct the related technical instruction. For apprentices at Developmental Services and Home Care Associates, time in related technical instruction takes place during work hours while it occurs during off-hours for apprentices in Good Samaritan, Air Force Villages, and Agape.
Progress in related technical instruction is monitored by the instructors and through tests. Tests measure the progress in related technical instruction for apprentices at all sites but the degree to which trainers oversee this process varies. As Good Samaritan uses self-administered related technical instruction activities, less oversight occurs. Attendance is also a key part of completing the related technical instruction requirements for the trainer-led instruction at Developmental Services, Home Care Associates, Air Force Villages, and Agape. At some sites, basic training is used as a screening tool for becoming apprentices. Developmental Services does not let staff work in group homes with clients until they successfully complete their basic training, and Home Care Associates uses performance in basic training (which all staff receives) to determine who continues on to receive the enhanced training provided through the LTC RAP. Agape instructors use weekly quizzes, hands-on demonstrations, and the palliative care exam to monitor apprentice progress.