As workforce challenges continue to plague the home-based care industry, providers and policymakers are leaning on training and apprenticeship programs to help close the gap.
In September, City College of San Francisco (CCSF), UC San Francisco (UCSF) and Homebridge, a San Francisco-based in-home care organization, teamed up on such an initiative.
Together, the three organizations formed an on-the-job training program for Homebridge workers. The program, funded by the San Francisco Office of Economic and Workforce Development and the Metta Fund, offers certified nursing assistant (CNA) certification through CCSF and links participants to on-the-job clinical training with UCSF.
“We’ve long wanted to look for a connection between our home care career ladder and a health care career,” Mark Burns, executive director of Homebridge, told Home Health Care News. “We wanted to give our workers the opportunity to move into better-paying careers, and create more of a career path pipeline for ourselves and the city and county of San Francisco.”
Homebridge provides an agency model of in-home supportive services to the city and county of San Francisco. Currently, the company employs 300 full-time caregivers and serves 1,000 clients annually. These clients are participants in the In-Home Supportive Services (IHSS) Program under Medi-Cal.
Homebridge manages roughly 5% of the total population of IHSS recipients in San Francisco.
When it came to training, Homebridge wasn’t exactly a novice. Over the years, the company had been recognized and even awarded for its 80-hour home care curriculum that was decades in the making, according to Burns.
“Our workforce is in three layers,” he said. “You come in and do a basic, week-long skills development. As time goes by, your supervisor can recommend you for advancement. We currently have three tiers, and it usually takes about a year and a half to two years for a worker to make their way through all three tiers. At each of the progressive tiers, they move up about $1 on our pay scale.”
In many ways, the partnership with CCSF and UCSF builds off of this foundation.
“It’s taken us a couple of years to put this program together,” Burns said. “We’ve been working mostly with [CCSF], as they have the accreditation to train CNAs. We’ve developed this program where we as the training organization and employer offer a 12-week on-the-job CNA program for people who have finished their third year of training at Homebridge and are interested in moving beyond and starting a health care career.”
Under the program, Homebridge employees are working three days a week, training one day a week, then doing clinical supervision one day a week.
“The clinical supervision part is where UCSF comes in,” Burns said. “They are a large medical system here in San Francisco, and they’re also a large employer of CNAs. They are going to be the clinical site for our CNA students. We are then hoping that our CNA graduates will get placed into either UCSF or one of the other large health care systems.”
For caregivers, CNA certification can often mean a pay bump. Burns noted that caregivers starting at an entry-level wage could see a bump to roughly $22 an hour.
Additionally, the pay for entry-level CNA jobs with organizations such as UCSF and Laguna Honda Hospital — another potential employer of workers who complete this program — starts around $25 an hour and goes up to about $35 an hour at the top, according to Burns.
Burns believes that the workforce shortage has forced providers to become proactive problem-solvers.
Caregiver wages and a lack of career advancement often make it difficult for agencies looking to recruit. This program addresses that directly.
“We’re having this tremendous shortage of low-wage workers, and the way in which we chose to solve that was by trying to create this pipeline and a channel — a career ladder,” Burns said. “We want to get people to come here and begin these jobs while offering them on-the-job training and a chance to advance. I think it’s a big step for the industry.”
Homebridge isn’t alone in viewing these types of programs as a path forward for home-based care.
On Thursday, Pennsylvania Gov. Tom Wolf announced a major expansion of Bayada Home Health Care’s Nurse Residency apprenticeship program. Bayada’s Jamison location is one of 8 offices that will benefit from a $297,000 award the company received through the Pre-Apprentice and Apprenticeship Grant Program.
“Many of us have known someone who has received in-home nursing service in the comfort of their own home and agree that the most qualified individuals are needed to serve our loved ones’ health care needs,” Wolf said in a statement. “As the demand for skilled in-home nurses continues, apprenticeship opportunities like these are even more crucial to help address this shortage. My administration is pleased to support Bayada as they expand their apprenticeship program, create new career paths for nurses and serve more people in communities across the commonwealth.”
The program gives Bayada a wider talent pool by placing recent licensed practical nurses and registered nurse graduates, who would otherwise not yet meet the company’s hiring requirements for prior work experience, into an apprenticeship.
The apprenticeship program will team up with local workforce development boards across Allegheny, Bucks, Delaware, Indiana, Lancaster, Lehigh, Montgomery, Northampton and Philadelphia.
Ultimately, the goal is to combat the national nursing shortage and increase access to care in the state, according to Cris Toscano, skilled nursing practice president at Bayada.
“As a home health care provider, we are acutely impacted by the ongoing, nationwide nursing shortage exacerbated by the COVID-19 pandemic,” she said in a statement. “Funding from [the Department of Community and Economic Development] will serve as an important scale-up investment in the state’s nursing workforce and will ultimately lead to our ability to care for more Pennsylvania residents in the comfort of their own homes, where they want to be.”
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