Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 2. Background on the Long-term CARE Apprenticeship Program (ltc Rap)


The apprenticeship model is distinguished by its integration of instruction and work; apprentices learn occupational competencies both in formal classroom settings and while working at a job that directly applies and reinforces those competencies. Structuring training in this way provides apprentices with an income during the training and helps assure that the skills they learn are useful to employers. In addition, the work-based learning offered by on-the-job training (OJT) helps apprentices to understand how their classroom instruction is relevant to their work. An essential component of apprenticeship is a clear wage and career progression. Wage progressions are often tied to the completion of certain occupational competencies, either in their classroom instruction, OJT, or both. This advancement opportunity provides an incentive for the apprentices to acquire skills demanded by employers.

Apprenticeship in the United States is highly decentralized with decisions made by individual apprenticeship sponsors regarding curriculum and program structure. Most programs operate within the Registered Apprenticeship system, which is overseen by DOL’s Office of Apprenticeship (OA) and state apprenticeship agencies. The OA and the state apprenticeship agencies certify program completion, protect the safety and welfare of apprentices, provide guidance and technical assistance to program sponsors, monitor program equal opportunity plans to prevent discrimination against women and minorities, and promote the expansion of the use of apprenticeship by employers. Only an apprenticeship program registered with the OA or a State Apprenticeship Agency and meeting the minimum requirements for standards of apprenticeship established in 29 CFR 29.5, can receive certification and be recognized across the country. Almost no direct government funds are spent on apprenticeship programs, including LTC RAP.

LTC RAPs, registered by the OA and developed by employers, employer associations and labor-management organizations, provide formal training and work experience for direct care workers in long-term care settings. Since the program’s inception in 2003, 119 long-term care employers have offered LTC RAP employment and training to 4,376 apprentices, including all workers regardless of whether they completed the apprenticeship or not (RTI International/Urban Institute analysis of program data, May, 2011 ).

Registered apprenticeship programs are primarily funded directly by employers with some assistance with start-up funding from government (including DOL) or private organization (e.g., foundation) grants. LTC RAPs include four main components. First, OJT occurs at a worker’s place of employment. Second, related instruction takes place either at the work site or at technical or community colleges. Related instruction may occur through various modes of instruction (e.g., in-person, web-based, correspondence course). Third, mentoring is often a feature of many apprenticeships, occurring sometimes through mentors who have completed apprenticeships themselves. Mentors provide on-the-job coaching and help apprentices identify and acquire competencies needed to perform their jobs successfully. The required hours of training for all of the LTC RAPs far exceeds what is normally provided by several orders of magnitude. For example, Agape Senior’s LTC RAP for CNAs in South Carolina requires 2,257 hours to complete, and includes 266 hours of related training instruction, which is more than three times the minimum federal requirement of 75 hours of training. Fourth, a clear wage and career progression is a key component of apprenticeship programs. Wage progressions are often tied to the completion of certain occupational competencies, either in their classroom instruction, OJT, or both. This advancement opportunity provides an incentive for the apprentices to acquire skills demanded by employers. Ideally, completion of the apprenticeship results in a job certification that is portable and meaningful to other employers.

Registered apprenticeships are structured to develop increased job competency over time. Apprenticeships can be either competency-based, time-based, or a hybrid of the two, a decision made by sponsors who can shape OJT and curricula previously developed by the OA to suit employer needs. All programs require apprentices to master a set of competencies, but like most schools, the time-based approach additionally require certain minimum hours of on-the-job and related instruction. Hybrid programs often require minimum time spent in on-the-job or related training.

Current LTC RAPs offer apprenticeships in four major occupations: CNAs, DSSs, HSSs, and HHAs. CNAs, work in nursing homes caring for persons with clinical needs or needing assistance with eating, bathing, and similar activities. The CNA apprenticeship is competency-based and offers two models, one with interim credentials and one without. In the interim credentialed model, apprentices must complete entry-level and advanced level training, which is followed by one or more specialties such as dementia or restorative care. After completion of each level and each specialty, apprentices receive a Certificate of Training. Upon completion of Levels 1, 2 and any specialty from Level 3, apprentices receive a Certificate of Completion of Apprenticeship.

DSSs provide care in group homes for persons with intellectual and developmental disabilities needing monitoring and assistance in daily activities. The DSS apprenticeship s a competency-based model with no interim credentials offered.

HSSs work in assisted living facilities and other residential care facilities providing care for mostly elderly persons needing monitoring and assistance with daily tasks. These residential care facilities usually do not provide the highly skilled clinical care that is provided in nursing homes, thus staff certification requirements for these two settings differ. The HSS apprenticeship currently is a hybrid model (time-based and competency-based) with no interim credentials.

HHAs work in home health and hospice agencies providing services to people living in the community having clinical needs or needing assistance with eating, bathing, and similar activities. The HHA model is a competency-based apprenticeship offering interim credentials or Certificates of Training when apprentices complete various levels of training within the occupation. The apprenticeship begins with entry-level (Level 1) training, of which at least 16 hours of classroom training must be completed before beginning the supervised practical training component. To receive the Certificate of Completion of Apprenticeship, apprentices need to complete Level 1 and then any two specialties.

Specialty training differs across the three occupations that have such training. CNAs can specialize in dementia care, geriatric care, restorative care, or mentoring. HHAs can specialize in care for people with disabilities, palliative care for patients receiving hospice, care for people with mental illness, dementia care, geriatric care, or mentoring. HSSs can receive specialty training in dining services, environmental services, or as an activity director, certified medication aide, certified nurse’s aide, HHA, or rehabilitative aide.

Generally, competency-based apprenticeship programs emphasize skill mastery without requiring a specified time commitment to training, although OJT ranges from 3 to 5 months for each level of training with varying amounts of related instruction. In contrast, time-based apprenticeships mandate occupational competencies apprentices must learn for certification within a fixed amount of time at the end of which participants receive a certificate. Time-based apprenticeships generally provide an extended period of entry-level training lasting a minimum of 2,000 hours, with at least 144 hours of related instruction.

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