Characteristics of Long-Term Care Registered Apprenticeship Programs: Implications for Evaluation Design. 4.3. Progression of Apprentices through the Program

09/13/2011

Senior staff, including supervisors, more experienced long-term care workers, nurses, and trainers play a role in monitoring and testing apprentices in all five sites, as discussed on Table 4. Shadowing, or following and observing, more senior staff as they perform tasks during early training sessions occurs at both Developmental Services and Home Care Associates. However, because Home Care Associates apprentices often conduct their work alone in clients’ homes, it is challenging for supervisors to monitor their OJT activities. The OJT portion of the apprenticeship at Air Force Villages is generally supervised. Apprentices at Developmental Services must have their medical knowledge re-tested at regular intervals after completing their apprenticeship. At Agape, supervisors use competency checklists developed at the same time as the curriculum to regularly monitor the performance of apprentices. The apprentices at Developmental Services and Agape had some sense that their OJT activities were being evaluated by supervisors, but they were often unaware of the extent of the supervision, or that checklists based on competencies were being used.

Mentorship is an essential component of registered apprenticeship, because mentors help apprentices understand the material they are expected to learn during OJT. Since long-term care work can be stressful, mentors assist and counsel apprentices in the program. At Home Care Associates, mentors are chosen from among more senior staff. As noted above, Home Care Associates presents a challenge for mentorship because HHAs provide care in the homes of clients. Senior staff at Home Care Associates are aware of this problem and emphasized the importance of mentoring apprentices when they are at the Home Care Associates headquarters. Mentorship is strongly encouraged at Good Samaritan, and apprentices are expected to mentor non-apprentice workers. While this expands the role of mentorship in the traditional apprenticeship model, Good Samaritan includes mentorship as one of its core competency trainings. These lessons are expected to be passed on to others once the training is completed. In addition to mentoring by supervisors, Developmental Services places a premium on the opportunity for peer-mentoring, particularly at monthly meetings held for staff at each group home. Mentors are expected to discuss problems with apprentices that may emerge during the course of direct care work, rather than only providing instruction. Mentorship training is also provided at Agape, and like the program at Good Samaritan, apprentices are expected to serve as mentors to other CNAs. The apprentices at Agape take their mentorship role very seriously because of the respect they receive from their mentees. While not formalized, mentorship is also valued at Air Force Villages where those who completed the apprenticeship program serve in this capacity.

Each LTC RAP recognizes somewhat different milestones for apprentices. Good Samaritan and Home Care Associates both acknowledge the completion of related technical instruction and OJT associated with individual competency trainings as a completed milestone, and reward each completed competency training with a wage increase. At Good Samaritan, this is because limited resources and job openings prevent the LTC RAP from guaranteeing that apprentices will be able to complete all competency trainings so progress is rewarded at completion of each competency training. Apprentices at Good Samaritan’s Boise and Idaho Falls campuses are awarded wage increases of $0.25 and $0.50 for each competency training completed, respectively. Apprentices at Home Care Associates are awarded a wage increase of $0.20 per competency for a typical total wage increase of $1.20 and a one-time bonus of $200 at completion. Agape provides a $0.25 raise at the end of each calendar quarter (for a total wage increase of $1.00), roughly coinciding with the completion of related technical instruction modules. Agape supervisors often provide special recognition for the apprentices under their supervision upon completion of the program, including gift certificates and celebratory dinners. Developmental Services does not offer a wage progression with every competency, but it does provide a one-time $1.25 per hour wage increase upon the completion of the basic training, which encompasses the first several weeks of the apprenticeship. Upon completion of the apprenticeship, Developmental Services staff are certified as direct service providers in the State of Indiana. Developmental Services also holds graduation ceremonies for their apprentices, and suggested that it is a major event for both apprentices and their families, who also attend. Air Force Villages offers a combination of wage progression and/or bonus of up to 8% of the employee’s base salary after all related technical instruction is completed.

While all sites acknowledge workers who complete the LTC RAP and recognize the achievement within their organization, Developmental Services and Home Care Associates offer credentials that arerecognized in the long-term care labor market. Developmental Services representatives actively participated in the state-level discussions on DSS credentialing in Indiana in 2007, where they successfully advocated for the inclusion of registered apprenticeship as one of three sources of a DSS credential. Although Indiana does not currently require DSS workers to be certified, Developmental Services anticipates that at some point there will be such a requirement. Home Care Associates representatives were similarly successful in lobbying the state legislature to develop certification requirements for HHAs that were based on the training and skills the company requires for its own apprentices. Despite the fact that these credentials are officially recognized by the state governments of Indiana and Pennsylvania, apprentices and administrators agreed that it was unclear whether other employers understood apprenticeship training or valued the apprenticeship. Apprentices at Agape similarly earn a palliative care certification that is widely recognized. Another advantage of the Agape apprenticeship is that since the diploma provided upon completion is administered by the Northeastern Technical College, it offers a degree of legitimacy with other employers who know and respect the South Carolina technical college system.

TABLE 4. Features of the Selected Long-Term Care Registered Apprenticeship Program Sites
Program Features Program Site
Indiana
Developmental Services
Program Site
Idaho
Good Samaritan
Program Site
Pennsylvania
Home Care Associates
Program Site
Texas
Air Force Villages
Program Site
South Carolina
Agape Senior
Program Goals
Improve the quality of client care --- X --- X X
Improve and expand skills of workforce X X X X X
Reduce medical errors and liability risks X --- --- --- ---
Meet state certification requirements X --- X --- ---
Improve self-sufficiency and career opportunities --- X X X ---
Reduce worker turnover --- X X X X
Total hours required for completing the program 3,000 1,680-2,180 2,025 3,232, although 2,000 hours may be credited for previous experience 2,256.5
On-the-job training hours 2,784 1,500-2,000 1,795 3,000 2,000
Related instruction hours 216 180 230 232 265.5
Mentoring or peer support Supervisors (who have finished the program) mentor-apprentices at all sites. Peer support occurs on-the-job, as well as in monthly meetings. Peer-mentoring is strongly encouraged by management. One purpose of the apprenticeship is to train CNAs who can mentor non-apprentices. Mentoring is harder because aides work alone in client homes, but apprentices are mentored at headquarters by their supervisors. Mentoring occurs in related technical instruction, but apprentices are expected to provide documentation of their progress in OJT to receive credit for the apprenticeship. Mentoring occurs during OJT but it is not formalized
Milestones Wage increase for completion of initial training; DOL certification of completion Wage increase for completion of each competency; DOL certificate of training Wage increase for completion of each competency; DOL certificate of completion Wage increase or bonus for completion of related technical instruction; DOL certificate of completion Certification of completion for each training unit; DOL certification of completion for entire program; National Test for Palliative Care Providers
Wage progression After completing basic training, they are given a wage increase commensurate with experience (typically a $1.25 per hour increase), from a base rate of $7.25. Apprentices receive wage increases upon the completion of a core competency. At the Boise and Idaho Falls facilities, this increase is $0.25 and $0.50, respectively. Apprentices receive a $0.20 wage increase upon the completion of a core competency, from a base rate of $8.50. Apprentices receive up to an 8% wage and/or bonus increase after related technical instruction is completed, from a base rate of $9.09. Apprentices receive a $1 increase upon program completion, from a base rate of $9 to $11.
Bonuses for completion (i.e., one-time only) None None $200 bonus upon completion of all competencies Up to 8% of salary upon program completion if no wage increase Small gift card as a bonus
Additional credential(s) earned beyond DOL interim certificate(s) of training, and certificate of completion at end of apprenticeship Become registered apprentices, state recognition as certified direct support providers No credentialing other than becoming a registered apprentice State certification as a HHA No credentialing other than becoming a registered apprentice Become registered apprentices and state certified palliative caregivers
SOURCES: Data collected from Interviews at and materials from LTC RAP sites, October 2010-June 2011.

Abbreviations: CNA (certified nursing assistant); OJT (on-the-job training); DOL (U.S. Department of Labor); GED (general equivalency degree): HHA (home health aide).

TABLE 5. Features of On-the-Job Training (OJT) Components of the Selected Long-Term Care Registered Apprenticeship Program Sites
On-the-Job Training Features Program Site
Indiana
Developmental Services
Program Site
Idaho
Good Samaritan
Program Site
Pennsylvania
Home Care Associates
Program Site
Texas
Air Force Villages
Program Site
South Carolina
Agape Senior
Hours spent in on-the-job training (weekly) Varies; typically 40 hours a week 32-40 hours a week 40 hours a week; Full-time employment guaranteed 32-40 hours a week Full-time employment hours
Resources used for on-the-job training Medical sheets to document and coordinate medication of clients None None A small amount of supervisor time None
Monitoring of progress Monitored by supervisors assigned to a group home, nurses, and trainers; progress reported to human resources Monitored by supervisors Monitored by supervisors, usually through follow-up with apprentices at headquarters or observations at client homes Apprentices expected to provide documentation of their progress based on apprenticeship outline Tests and quizzes after each training unit OJT monitored by supervisors
SOURCES: Data collected for Interviews at and material from LTC RAP sites, October 2010-June 2011.

TABLE 6. Features of Related Technical Instruction Component of the Selected Long-Term Care Registered Apprenticeship Program Sites
Related Technical Instruction Features Program Site
Indiana
Developmental Services
Program Site
Idaho
Good Samaritan
Program Site
Pennsylvania
Home Care Associates
Program Site
Texas
Air Force Villages
Program Site
South Carolina
Agape Senior
Hours spent in related technical instruction (weekly) Varies; 30 hours per week in initial weeks, with training scheduled at regular intervals afterward Varies Varies 8 hours per week 3 hours weekly
Provider of related technical instruction Training provided by in-house instructors, with curriculum developed by Indiana University Self-administered training with DVDs and workbooks provided by Good Samaritan Training provided by two instructors, one of whom was a former apprentice Initially the training conducted on-line by the North Central Kansas Technical College; now taught by several in-house managers Training provided by instructors who are mostly in-house experts; hired from outside for one course on dementia
Related training built upon pre-existing training at the organization Yes No Yes No No
Payer of related technical instruction Developmental Services, supported by funding from the United Way, private donations, fund-raisers, and ARC Good Samaritan Home Care Associates, supported by the Philadelphia Workforce Development Corporation and two foundations DOL grant initially supported training, but now Air Force Villages provides instructors to teach classes during work hours Agape Senior
Related technical instruction takes place during work hours Yes No Yes Varies No
Required courses Medical orientation, CPR, core medical training, conflict prevention and resolution Advanced CNA training, and one additional competency from among mentoring, restorative, dementia, and medication administration Case management, peer-mentoring, best practices, and communication, working with clients with physical disabilities, hospice care, and mental illness Medical terminology 1, medical terminology 2, environmental services, restorative, dementia, person-centered care, activity assistance, and soft skills* Advanced CNA (geriatric and mentoring competencies) and palliative specialty
Monitoring or progress Monitored by the trainer in the classroom, and by competency tests Must complete a workbook, which is certified by an LPN or RN. A competency checklist is completed with an RN. Progress monitored by instructors and more senior aides who discuss application of classroom training on-the-job with apprentices. Weekly quizzes, midterm exams, module tests, homework assignments and attendance requirements Quizzes, module tests
SOURCES: Data collected from Interviews at and materials from LTC RAP sites, October 2010-June 2011.

Abbreviations: DOL (U.S. Department of Labor); CNA (certified nursing assistant); LPN (licensed practical nurse); RN (registered nurse); ARC (Appalachian Regional Commission); CPR (cardiopulmonary resuscitation).
* NOTE: Soft skills include communication skills with staff and clients, managing stressful situations or difficult clients, anger management.

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