The LTC RAP represents a more substantial commitment to training than is typical in long-term care. As an approach to training in the long-term care industry, LTC RAPs are still in their early stages and have not diffused fully across the industry. Among the strengths of these apprenticeship programs are the emphasis on mentors and peer-to-peer learning, learning by doing, and the integrated learning through theory and practice. Nonetheless, compared to traditional apprenticeship programs for occupations like plumbers, electricians or carpenters, the LTC RAP faces numerous serious challenges.
It is a relatively new approach in the long-term care field; as yet, few providers in long-term care have heard of or are knowledgeable about the LTC RAP; as a result, completing the apprenticeship program provides little recognition outside of the sponsoring employer. As a result, the certificates of completion may not have value as a credential respected by other employers for entry into jobs with higher salaries and access to more responsible positions. If the program were to expand, the apprentices completion credential might increase in value.
Employers, often constrained by payments from public programs (principally Medicaid), are unable or unwilling to provide substantial wage increases to apprentices completing the apprenticeship program. In our site visits, apprentices completing the program received wage increases of $0-$1.25 per hour. This is consistent with other findings that there is little wage growth with longer job tenure among CNAs working in nursing homes (Wiener, Squillace, Anderson, and Khatutsky, 2009 ).
Completing the apprenticeship is not a rung on a well-established career ladder. Few providers have job titles for direct care workers with advanced training, although some states are beginning to recognize career lattices as well as ladders in their regulations and nurse delegation legislation. Moreover, apprenticeship experience and training as CNAs, HHAs, DSSs and HSSs does not typically allow them to move to higher level clinical or management positions. In almost all cases, moving up in the organization requires obtaining additional formal education (e.g., becoming a licensed practical nurse requires going back to school).