Long-Term Care Workforce

Characteristics of Long-Term Care Registered Apprenticeship Programs: Implications for Evaluation Design. Glossary

AAI -- Advancing Apprenticeship Initiative, a U.S. Department of Labor (DOL)-led initiative to promote the expansion of registered apprenticeship to high-growth industries that traditionally do not use the apprenticeship model for employer-sponsored training. CNA -- Certified Nursing Assistant, an occupation in which employees work in free-s

Characteristics of Long-Term Care Registered Apprenticeship Programs: Implications for Evaluation Design. Acknowledgments

The authors appreciate the time and information provided by representatives, apprentices, and partners of the long-term care registered apprenticeship programs we visited to conduct this study. We also thank our Co-Project Officers, Marie Squillace in the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Healt

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 8. References

American Health Care Association. (2010). Report of findings 2008: Nursing facility staff vacancy, retention and turnover survey. Washington, DC: American Health Care Association. Available at: http://www.ahcancal.org/research_data/staffing/Documents/Retention_Vacancy_Turnover_Survey2008.pdf .

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 7. Conclusion

The long-term care industry faces shortages of highly trained direct care workers. As a result, the industry struggles to improve quality of care and the lives of workers, who often receive low wages and few fringe benefits. Jobs, such as CNAs and HHAs, are often viewed as dead-end jobs, with little opportunity for career advancement. While appren

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 6.4. Cost-Benefit Analysis

Employers in long-term care are highly constrained in what they pay their workers, face government training requirements even if they do not offer apprenticeships, and often pay low-wage rates even to highly qualified workers. As in any service industry, productivity in long-term care is hard to measure. Indeed, in some cases, increased efficien

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 6.3. Focus Groups

Primary data collection using focus groups may provide a low-cost research design option that would obtain information to inform policy. Focus groups would provide a means for apprentices to voice opinions on a range of topics about how the apprenticeship program works from their perspective, its strengths and weaknesses, and how it could be impro

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 6.2. Survey Option for Apprentices

Survey data collection and analysis is a potential evaluation option to address research questions regarding the apprenticeship experience on topics not available in secondary data. For the LTC RAP evaluation, a survey of apprentices would provide systematic quantitative information on the experiences of apprentices with the LTC RAP compared to di

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 6.1. LEHD Quasi-Experimental Evaluation Option

This option for evaluating the LTC RAP relies on using RAPIDS administrative data on LTC RAP apprentices combined with employer and employee information from the LEHD database, a Census Bureau data file that includes state-level Unemployment Insurance administrative information on employment and earnings. This quasi-experimental strategy identifie

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 6. Detailed Description of Four Approaches to Evaluating the LTC RAP

In this section, we describe a four component approach to evaluating the LTC RAP. The four components are: (1) use of the Longitudinal Employer Household Dynamics (LEHD) administrative dataset to compare apprentices with non-apprentices and LTC RAP employers and non-employers; (2) a cross-sectional telephone survey of apprentices and non-apprentic

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.6. Evaluation of Broad Options

In reviewing the options presented in this section, it is necessary to weigh the importance of the questions to be asked, the feasibility of the approach, the scientific rigor of the evaluation design, and the cost of implementing the design. Ultimately, the decision about whether to implement an evaluation and which one is a question of value for

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.5. Control or Comparison Groups

The essence of evaluation research is to answer the question: How do the outcomes of the participants in the intervention compare with the outcomes they would have experienced had they not participated? For this evaluation, the focus is on how the LTC RAP training affects workers and employers compared to the standard training that direct care wor

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.4. Data Sources

To conduct an evaluation of this type, several qualitative and quantitative methods and sources of data could be used. These include:

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.3. Evaluation Designs to Determine Effects on Employers

Exhibit 4 presents a range of research designs for the evaluation of the programs effects on employers and pros and cons for each design. These designs are not necessarily mutually exclusive and could be combined in various ways. The relatively small number (119 across four occupational categories) of programs limits the evaluation design

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.2. Evaluation Designs to Determine Effects on Apprentices

Exhibit 3 presents a range of illustrative evaluation designs for the evaluation of the LTC RAPs effects on apprentices, ranked from strongest to weakest according to scientific rigor. The strength of the design is an assessment of how well the findings can be defended as measuring the true effect of the intervention as opposed to resultin

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5.1. Outcome Variables

Exhibit 2 is a list of potential outcome variables for workers and employers for an evaluation of LTC RAPs. Some of these outcomes, such as wages and turnover, can be obtained from employers or from administrative records without having to ask the apprentices and the comparison group. Other outcomes, such as intent to leave, job satisfaction

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 5. Assessment of a Broad Range of Evaluation Options

There are many possible research designs for an evaluation of the LTC RAP, with varying costs and degrees of scientific rigor. Most evaluations of job training programs focus solely on the program participants, mainly their level of participation, knowledge and skill improvements and gains in earnings. However, since many of the policy motivations

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 4.6. Limitations of the Intervention

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 le

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 4.5. Limited Data Available at Sites

One possible source of data in some evaluations is administrative data that is routinely collected by the employer sponsors whose programs are being evaluated. LTC RAPs report some data to DOL through RAPIDS. In terms of evaluation, RAPIDS data is useful for identifying the universe of sponsors and apprentices, and some socioeconomic characteristi

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 4.4. Selection Bias and Comparison Groups

The essence of evaluation research is asking whether the outcomes of the intervention group are different from those of some comparable comparison group which did not receive the intervention. Developing comparison groups for LTC RAP apprentices and programs will be challenging because of the selection bias inherent in the way apprentices are chos

Evaluation Design Options for the Long-Term Care Registered Apprenticeship Program. 4.3. Length of Intervention

The length of the LTC RAP programs is an important issue for any evaluation because of its implications for the cost of data collection. An evaluation that involves measuring the apprentice at the beginning and the end of the program (and perhaps during the course of the program and afterwards) would need to consider how long it is necessary to fo

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