Characteristics of Long-Term Care Registered Apprenticeship Programs: Implications for Evaluation Design. 5.3. Partner Roles and Resources

09/13/2011

The LTC RAP sponsors work with an array of partners to provide care and to maintain their apprenticeship programs. The roles these partners play fall into three basic categories: funders, referral sources, and training providers (Table 8). The primary role of the partners is funding training and other LTC RAP expenses. Most sites found these partners important to the success of the apprenticeship.

The budget constraints faced by long-term care providers visited create strong incentives to seek external funding for the LTC RAPs. Developmental Services incurs $500,000 in costs for the organization (not only training expenses) that are not covered by Medicaid reimbursement annually, and pays for these expenses through foundation support. Donations and grants are received through the United Way, individual donors, fund-raising events, Appalachian Regional Commission (ARC) funds, and other grants. These funds help to cover apprentice training and wage progressions. Developmental Services’ longstanding relationship with the United Way has allowed it to consistently provide high-quality direct support services despite reimbursement rates that staff believe are inadequate.

Home Care Associates supports its related technical instruction specifically through two partnerships: one with the Philadelphia Workforce Development Corporation, and one with the Patricia Kind Family Foundation and the Pew Charitable Trusts. The Workforce Development Corporation provides an Industry Specific Partnership Initiative training grant, a state-led effort, to fund basic training of HHAs receiving TANF. The Patricia Kind Family Foundation grant funded enhanced training for all apprentices at Home Care Associates. Good Samaritan has initially received a Council for Adult and Experiential Learning grant to start their LTC RAP. Subsequent funds from National Alzheimer’s Association assisted Good Samaritan in finishing their dementia care training material.

Other partners have helped more directly with content and provision of the apprenticeship training. For example, while related technical instruction is provided onsite at Developmental Services, the curriculum for the medical training was developed in partnership with Indiana University. Air Force Villages developed their program materials after considering a CNA curriculum developed by faculty at the North Central Kansas Technical College (NCKTC) that was used in the on-line training program first used for the LTC RAP. Partner organizations also play a role in introducing long-term care providers to registered apprentices in the first place. Home Care Associates was introduced to the apprenticeship model through its partnership with the PHI.

Agape has been better able to fund its own training than the other four sites, but it also pursued financial support from the workforce investment system and from the South Carolina Department of Employment and Workforce when it started its RAP. Like Developmental Services, Agape developed its curriculum and competency checklists in cooperation with a local educational institution, Northeastern Technical College. While the college is not currently involved in the registered apprenticeship program training, it continues to supply Agape with new CNAs who graduate from basic CNA training at Northeastern. Finally, Agape does receive state support through a one-time $1,000 apprenticeship tax credit for each registered apprentice.

The OA and SAAs have also been important and active partners for many of the LTC RAPs, especially in their initial stages. The OA in Indiana worked with Developmental Services to convince the State of Indiana to include registered apprenticeship as a valid fulfillment of the requirements for the direct support certification. The Indiana OA also helps to promote the program and find applicants for the LTC RAP at job fairs. Air Force Villages also received a DOL grant to fund the first on-line course taken by apprentices, although this grant has ended. Home Care Associates worked with OA in Philadelphia to start its LTC RAP based on a program in New York developed by PHI. Registered apprenticeships in South Carolina are administered through the state technical college system, which collaborated closely with Agape in designing its LTC RAP and provided technical assistance.

The partnerships with the workforce investment system (the public employment and training system authorized by the Workforce Investment Act of 1998) and unions are minimal. The workforce investment system occasionally refers job applicants to Developmental Services and Home Care Associates but has no involvement in the LTC RAPs. Two reasons for the lack of partnership may be: (1) the program is not considered a primary responsibility of the workforce investment system; and (2) most apprenticeship sponsors do not reach out to the system. Agape Senior had a more substantial relationship with the workforce investment system, which provided a grant to fund related technical instruction for its first cohort of trainees in 2009. Workforce investment funds were not available in subsequent years to support Agape’s program, but the workforce system in South Carolina is generally supportive of and receptive to apprentice programs in the state. No relationship exists between the workforce investment system and Good Samaritan or Air Force Villages. A union, the 1199 Service Employees International Union (SEIU) in Philadelphia, occasionally provides some training for Home Care Associates in which apprentices may participate. No unions partner with Developmental Services, Good Samaritan, and Air Force Villages. There are no partnerships with entities within the long-term care infrastructure such as the state Medicaid program, state units on aging, or area agencies on aging that have involvement in the LTC RAPs, because the apprenticeship programs are viewed as an internal, often experimental, training method with no direct relevance to the work of the Medicaid program or other state agencies. These agencies are involved in monitoring and regulating the sponsors’ delivery of care, but do not oversee training efforts such as the LTC RAPs.

TABLE 7. Staffing and Resources of the Selected Long-Term Care Registered Apprenticeship Program Sites
Staffing Characteristics 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
Training and supervisory staff operating LTC RAP 30 supervisors; 2 instructors 6-8 shift supervisors (RNs) and some LPNs 1 instructor 7-8 instructors 1 program director, multiple instructors, several RN supervisors
Roles of Staff Supervisors monitor progress of apprentices on site; trainers provide related instruction and document fulfillment of core competencies in related technical instruction and OJT. Staff administer checklists of skills; other experienced CNAs mentor-apprentices. Staff instructs and tests apprentices on related technical instruction material. Develop and customize materials, provide instruction, provide some oversight of OJT. Supervisors monitor progress of apprentices on site; trainers provide related technical instruction and document fulfillment of core competencies in related technical instruction.
Special qualifications for staff Medical trainer is an LPN; all supervisors completed the program. Mentors are former or current apprentices. Instructor is a former apprentice. Instructors are management staff within organization with direct content experience. Program director has background in education; instructors are management staff within organization with direct content experience.
SOURCES: Data collected from Interviews at and materials from LTC RAP sites, October 2010-June 2011.

Abbreviations: OJT (on-the-job training); CNA (certified nursing assistant); LPN (licensed practical nurse); RN (registered nurse).

TABLE 8. Role of and Resources Contributed by Partners at the Selected Long-Term Care Apprenticeship Sites
Partner Types 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
Federal Office of Apprenticeship or state apprenticeship agencies Indiana Office of Apprenticeship National Office of Apprenticeship Philadelphia Office of Apprenticeship San Antonio Office of Apprenticeship South Carolina Department of Employment and Workforce; Office of Apprenticeship; U.S. Department of Agricultural Rural Utilities Service
Community-based organizations and foundations United Way provides additional funding Center for Adult Education and Learning provided an initial program start-up grant Philadelphia Workforce Development Corporation, Patricia Kind Family Foundation, and the Pew Charitable Trusts provided training grants --- Agape Foundation
Workforce investment system Local workforce investment board occasionally refers applicants --- Local workforce investment board occasionally refers applicants --- South Carolina workforce investment system provides $1,000 tax credits for each apprentice
Educational institutions (secondary or post-secondary) Indiana University developed training curriculum and output measures --- --- Initial curriculum developed by North Central Kansas Technical College Northeastern Technical College provides related technical instruction
Industry groups Southern Indiana Provider Network provides best practices and promotes the program --- PHI provided technical assistance on the establishment of the apprenticeship program Pioneer Network, Sage Action PACT, PHI resources were used in developing curriculum ---
Unions --- --- 1199 SEIU provides training on occasion --- ---
SOURCES: Data collected from Interviews at and materials from LTC RAP sites, October 2010-June 2011.

Abbreviations: PHI (formerly known as Paraprofessional Healthcare Institute); SEIU (Service Employees International Union).

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