The LTC RAPs visited collect a limited amount of outcome data. This was often because of resource and time constraints and no formal monitoring of the performance of the program. Staff at all the sites indicated that they collect data on wages, benefits, promotions, tenure, and turnover (Table 10). Home Care Associates and Air Force Villagesstaff mentioned that they track wage and bonuses given to apprentices for completing the LTC RAP. Developmental Services, Home Care Associates, and Agape staff noted that they have tracked client satisfaction but have not linked the results to the LTC RAP. Anecdotally, supervisors at Agape have observed that clients are more satisfied with apprentices or apprentice completers than they are with other CNAs. No sites reported that they tracked whether the LTC RAP had an effect on worker satisfaction, worker productivity, or quality of care.
Data on apprentice turnover, measured as the number of workers who leave the sponsor that need to be replaced divided by the average number of employees, are not currently collected in all sites. However, all say that turnover can be calculated from employment records. Some sites measure turnover for both their general staff and for apprentices, specifically. For example, Developmental Services has a 49% annual turnover rate for apprentices and Air Force Villages has a 4% monthly turnover rate for all employees. Home Care Associates reported a 57% turnover rate for all employees, although staff indicated that only a few apprentice completers have left its employment with one moving on to become an RN. Good Samaritan experienced a 4% turnover rate in 2010 among active apprentices and those apprentices who enrolled but did not complete the apprenticeship. Agape had a similarly low turnover rate of 7% for its first cohort of apprentices. The site plans on calculating the one-year turnover rate for its second cohort in the fall of 2011, but staff expect the turnover rate to be at 0% (i.e., 100% retention). Since turnover data are not provided in the RAPIDS data, it is unclear how these statistics compare to non-apprentice long-term care staff generally. Anecdotally, Developmental Services staff suggested that its turnover rates were comparable to other direct support providers in southern Indiana. Lower turnover rates for Air Force Villages apprentices may be the result of the selection process that identifies workers that are likely to succeed as a HSS, and the reduction in turnover cannot be attributed to the LTC RAP.
Developmental Services maintains an information system recording client feedback and satisfaction, and staff noted that most other direct support providers in Indiana maintain similar information. Indiana University assisted Developmental Services in collecting these data and ensured that it collects information that is comparable to other client satisfaction databases. The outcome data currently collected are rarely used to monitor the performance of the LTC RAP. Staff at Home Care Associates also indicated that they collect outcome data on apprentices but do not use it for performance monitoring other than for turnover. Air Force Villagesstaff reported that turnover rates appeared to decline after the LTC RAP was established cannot attribute this directly to the LTC RAP. Air Force Villages staff also noted that turnover rates have declined, possibly as a result of the recession. Developmental Services staff noted that its measurement of client satisfaction is difficult to use as an assessment tool of apprentice performance because the situation of every client is different and not easily compared across apprentices. They also indicated that some apprentices leave the sponsor for jobs with other direct support providers but have returned because they prefer the work environment at Developmental Services.