One of the greatest barriers to the sustainability of the LTC RAP is the high cost of training and incentives to participation such as wage increases. These high costs almost always were reported in interviews, but sponsors did not provide the study team with any detailed documentation. Employers by nature are propriety about their business operations and some sponsors may not have wanted to provide details on costs. Some sponsor staff noted that such costs were incurred as part of the sponsors management staff responsibilities and did not record the separate costs for design and implementation of the LTC RAP. Nor were costs for materials development presented. Only one site, Home Care Associates, calculated that the related technical instruction costs for one apprentice as between $8,000 and $10,000. This program appeared to be at the high end of costs because of various more expensive training components involved. Home Care Associates ultimately discontinued its LTC RAP precisely because of the challenge of these costs when its foundation support ended. For Home Care Associates as well as other home health care service sponsors, demand for long-term care services has declined during the recession as some families began providing care themselves. In addition, Medicaid budgets and reimbursement rates have been reduced as state tax revenue declined with the economy. Sponsors attempted to cover costs that could not be covered by normal revenues with grants and other philanthropic donations. Unfortunately, these funds have also been more difficult to obtain because of the recent recession.
The costs of developing sufficient training resources were also a barrier to sustainability. Good Samaritan and Air Force Villages management noted that they prepared much of their materials at considerable costs in management time. Air Force Villages stated that DOL could help sustain LTC RAPs by developing related technical instruction materials and resources so that sponsors could focus on recruitment activities and OJT. The only site that did not cite cost issues as a major barrier to sustainability, Agape, suggested that it expected to expand the size of the program. Agape staff acknowledged the costs in management time required to develop the curriculum, but considered them a one-time cost. Agape staff found the financial assistance provided by South Carolinas $1,000 per person apprenticeship tax credit particularly helpful, and suggested that other LTC RAPs would benefit from other states providing this level of support for apprenticeship.
Recruitment also has the potential to pose problems for sustainability. If qualified and interested applicants are not available, then apprenticeship programs cannot be sustained. However, this did not seem to be a major issue to the LTC RAPs visited. All five registered apprenticeship programs except for Developmental Services only offered apprenticeships to select employees and they thought their employee pool had a sufficient number of qualified individuals. Developmental Services staff reported that they were not worried about recruitment as a threat to its sustainability, although they did note that its applicant pool is not always well-qualified. They suggested that they never receive enough qualified applicants that they would turn anyone away. In a labor market with many low-skilled individuals looking for work, overall recruitment for the sites was not cited as a problem.
Another factor to program sustainability noted by some sites was the need for buy-in by the firms leadership. Developmental Services has dedicated all of its training resources to the LTC RAP and leadership in the organization has supported the use of the program for all employees. Some sites are still testing whether apprenticeship is the right training approach on a subset of their staff and sponsor leadership has not supported full implementation. For example, Good Samaritans program is voluntary for its facilities to offer and for employees to participate. Home Care Associates supports the program only for its top-performing HHAs and the program is offered only when resources are available.
One concern of apprentices -- the lack of a recognized and portable credential -- may hinder the sustainability of LTC RAPs. For example, staff and apprentices at Home Care Associates noted that while the apprentices are proud of earning their apprenticeship credential, they also find it challenging to communicate the meaning and the value of the credential with other individuals in their field. This is especially problematic as the site is working with its state industry association and the state to develop a licensing requirement for HHAs. However, the use of a community or technical college as a training provider may lend credibility to the apprenticeship credential. For Agape apprentices, they saw their apprenticeship credential as legitimate and recognizable because it was from the local technical college where they received related technical instruction.
The sites visited rarely reported partnerships with the workforce investment system, the educational system, or the long-term care industry, all of which often help sustain training programs. For example, staff seldom identified partnerships with One Stop Career Centers, community colleges, or long-term care industry groups. The lack of such partnerships may greatly hinder sustainability. For Developmental Services, the educational system was a competitor for providing training that the sponsor could conduct more cost-effectively in-house. Similarly, long-term care industry groups were not involved as partners other than providing some technical assistance early on in the program development. The impetus for developing such partnerships may need to come from the partnering organizations as opposed to the sponsors to be seen as valuable.