LTC RAPs offer a distinctive model for expanding the amount of training and expertise of long-term care workers. If successful, the program will improve the productivity of workers and reduce turnover, thereby making wage increases possible without adding to the costs. Moreover, LTC RAPs will give employers confidence that their trained workers have the appropriate competencies. The descriptive analysis of the RAPIDS data provides a starting point for understanding the nature of the current status of LTC RAPs. This section discusses the relevance of the findings for the current task order.
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4.1. Apprentice-Level Findings
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Over the 5-year analysis period from January 2005 to December 2009, there were 3,744 apprentices (of which 1,445 apprentices are currently active (registered)) representing four broad occupations -- CNAs, DSSs, HSSs and HHAs. While age distributions varied across occupations, a majority of apprentices were age 30 and older (although a majority of apprentices in the CNA and HHA occupations were under age 30).
In comparison to national data such as the National Nursing Assistant Survey and the National Home Health Aide Survey, RAPIDS data show that apprentices are considerably younger, less educated and include more males than CNAs and HHAs working in the field nationally. Generally, it appears that apprenticeships for these two occupations are functioning as an early/entry career training program for people just starting out rather than for retraining of existing workers. No similar comparison data are available for DSSs and HSSs, both of which lack a clear set of national training requirements. Therefore, apprenticeships for these latter occupations may be serving as a type of credentialing in the absence of formal national training requirements.
Most of the apprentices are female, but there is a higher representation of males among DSSs, perhaps because persons with intellectual disabilities have a higher proportion of male clients, potentially necessitating a larger male presence in facilities serving this population. It may also be related to the fact that direct support work in this occupation involves less hands-on personal care.
Generally, apprentices comprise a group with low educational attainment. Apprentices rarely have college education and high proportions of some occupations did not complete high school, not surprising given that these are low-wage jobs. Again, comparisons to the National Nursing Assistant Survey and the National Home Health Aide Survey demonstrate that apprentices have lower levels of education than CNAs and HHAs working in nursing facilities and home health agencies nationally. In part, apprentices may be participating in apprenticeships to try to compensate for their lack of formal education.
LTC RAPs provide training to many minorities. RAPIDS analyses show that apprenticeship programs manage to recruit a relatively diverse group of people; overall, 30% are non-White or Hispanic. There is substantial variation in terms of diversity across occupations: the CNA occupation attracts the most diverse group of apprentices compared to DSSs that enroll the least diverse group of apprentices.
A key issue for these programs is the proportion of apprentices completing training versus the proportion who has cancelled their participation. Since January 2005, over 27% of workers in the data have completed an apprenticeship, versus 34% who have cancelled their involvement over time. Even in calendar year 2009 alone, more than twice as many apprentices had cancelled their participation (18%) as those who completed their training (7%) although not everyone who may have started in 2009 may have had enough time to potentially complete it by years end.
Among CNAs and DSSs, who together account for the large majority of apprentices in the data, although one-third of apprentices in each occupation have completed their training, one-third in each occupation has cancelled their training. Only 13% of HHAs had completed their training, coupled with a very high proportion of cancelled trainings (62%). It is troubling that the proportion of cancellations is at least as high or higher than the proportion of completions. Long-term care workers have a very high turnover rate, partly because of low wages. The wage rates in LTC RAPs are still low, so it is not surprising that many do not complete training. An issue for a future evaluation is how well apprentices compare to non-apprentices on measures such as turnover.
The apprenticeships average 2,100 hours in length, approximately one year, which includes about 200 hours of related instruction, which is offered by the employer for about three-quarters of participants. This level of related instruction is far beyond the minimum federal training requirements of 75 hours for CNAs and HHAs. Although many states mandate more than 75 hours, they do not reach the 200 hours of related instruction that is required under the LTC RAP.
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4.2. Program-Level Findings
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Overall, 121 programs are included in the database and described in this analysis. Almost half (46%) of all programs are for CNAs, about one-fourth are for HSSs (28%), 15% are for DSSs, and only 10% are for HHAs. There are only 35 apprentices in the HHA specialty competencies, too few to warrant further refined analyses of those specialty programs at this time.
The mean total workforce size of the CNA programs (1,803) dwarfs the total workforce size for the programs for the remaining major occupations, whose workforces range in the low hundreds, but this is the result of a few large hospital systems with nursing home businesses affiliated with them. Although there is current major demand for CNAs nationally, it is unlikely that nursing homes will be the setting of the biggest growth in long-term care jobs. Only programs with CNA and DSS apprenticeships involve multiple sites, with the remainder having only one location. Only six programs are nationally sponsored (all are for CNAs). Half of the programs (61) are in one DOL region (the Midwest), while the rest are spread fairly uniformly over the remainder of the DOL regions. DSS programs are the only major program type where a majority or plurality of programs is not in the Midwest, but in the West, where seven of the programs (39%) are located.
Although not all programs report data on the length of the overall apprenticeship and its related instruction component, those that do average about 2,000 hours overall and 319 hours for the related instruction component. The largest overall apprenticeship length is for DSSs, which averages 3,267 hours, which is twice as long as that of the next longest apprenticeship overall length (1,783) for CNAs. Potentially, DSSs might have been given more credit for prior time worked than other major occupations.
Regarding related instruction, community colleges and vocational schools provide important contributions in addition to those of program sponsors, who may not be able to provide such training if their organization is relatively small. The most common source of related instruction is community colleges (38% of all programs), followed by the sponsors themselves providing onsite training (27%) and then through vocational schools (23%). This differed by major occupation, with 45% of CNA programs using vocational schools for this component, 44% of DSS programs and 75% of HSS programs favoring community colleges, and 77% of home health agencies providing this instruction onsite at the employer.
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4.3. Assessment of RAPIDS Data for Use in Planning for or Conducting a LTC RAPs Evaluation
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The RAPIDS data provide insight into many characteristics of apprentices, apprenticeships, and sponsoring programs. Most importantly, given they include the universe of apprentices and programs, counts of each provide a broad measure of entrants at any time or the total number of apprentices or programs over time. As such, these data can be used for program reporting, for monitoring overall enrollment trends, and for showing a range of worker and program characteristics. For example, data on the variety of sources of related instruction (e.g., community college, correspondence course) reveal several ways programs interface with the community when training apprentices.
Of special interest to this project is the use of the data by the RTI/Urban team to help identify programs for site visits and for thinking about what is possible for a large-scale evaluation. Specifically, the list of programs by region and counts of currently enrolled apprentices by major occupational group can be used for helping select sites to visit in the current project. After identifying a subset of possible programs to visit, the RAPIDS data could be used to narrow the subset according to other characteristics in the data. For example, decisions about choices of site visits will be informed by data on programs that have several apprentices in the advanced or specialty occupations or programs that have both a large proportion of cancellations and a large number of currently enrolled apprentices.
Because the RAPIDS data are usually entered by sponsors and not through a centralized data entry function, much of the RAPIDS data lack certain characteristics for use in quantitative analysis for a future evaluation. First, there are large amounts of missing data in many data fields. Second, timeliness of data entry or updates may vary across employers, which would be important for data that is particularly time dependent (e.g., wages, enrollment status). Third, some problems encountered by employers interviewed for this report may prevent employers generally from entering completely reliable data.
Fourth, while some data probably have little or no measurement error in terms of data entry accuracy because they change little over time or are observed without error (e.g., demographic characteristics), other data had obvious problems due to either data entry error or variability in coding the same data fields by different programs. For example, according to DOL staff, the starting wage could be entered as either the actual beginning wage of an apprentice or the wage entered on the apprentice agreement, which may or may not be the actual wage. As a result, our preliminary analysis of the wage data showed that the pre-apprentice wage may be larger than the starting wage, and the ending wage may be less than the starting wage. Because of these issues, for quantitative data that may have a narrow range or are expected to change but only by small amounts over time (e.g., wages), a future evaluation contractor would probably need to collect such data in a centralized fashion and employ a range of data entry quality control measures to reduce potential measurement error.
Fifth, the data lack certain important measures of the effects of apprenticeship over time. For example, because RAPIDS includes no data on whether an apprentice is still employed at the same or another employer, one cannot estimate placement and retention rates. Such data could potentially be acquired from unemployment insurance data records. In addition, the system lacks data on employer costs and benefits because the OA does not have the authority to collect it. Finally, the RAPIDS system does not include data on one of largest future sources of apprenticeships, the expected large-scale implementation of apprenticeships in Washington State. Given the size and scope of that future project (and potential other large projects in various states), any future evaluation will have to obtain data that goes beyond the current RAPIDS database.
The RAPIDS data are useful for monitoring enrollment trends and understanding various characteristics of apprentices and programs. But, additional data sources designed explicitly for any future evaluation effort will be needed to support quantitative analysis, especially key outcomes such as turnover and program costs. Further, at their current scale, most LTC RAP programs are too small and too dispersed geographically to support detailed analyses and separate evaluations. Any future evaluation will depend on having a large enough number of apprentices participating in apprenticeships over time to provide a large enough sample in each occupation for evaluation. As of December 2009, only 1,444 apprentices were currently participating in training (registered), with only approximately 300-600 apprentices in each major occupation, except for HHAs, of which there were only approximately 100 currently registered apprentices.
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