Collaborate with competitors to recruit home health aides
Alliance boosts local paraprofessional supply
Is the phrase "I can’t find enough home health aides!" a familiar refrain in your community? Then consider joining with other providers to create a home health aide recruitment and training program.
A group of home care companies and nonprofit agencies in Madison, WI, has done so and increased the local supply of certified nursing assistants (CNAs), according to those involved.
The YWCA, a Hispanic service organization, and three home health agencies founded the CNA Career Alliance in 1997. The program trains welfare-to-work mothers and other low-skilled, working poor individuals to become CNAs. The Urban League of Greater Madison has since replaced the Hispanic service organization and a fourth home care company has become an Alliance partner.
Demand exceeds supply
The collaboration resulted from brainstorming among home health and community-based organization executives, according to Rita Giovannoni, MS, executive director of Independent Living, one of the founding organizations. The greater Madison area unemployment rate has been below 3% since 1988, but many people are marginally employed in low-paying jobs with few or no benefits, she explains. At the same time, the demand for paraprofessional home care workers far exceeds the supply. These factors, combined with Wisconsin’s welfare reform initiative, says Giovannoni, lead CNA Career Alliance founders to believe they were on to something.
"We represented the supply and demand sides [of certified nursing assistant care], were established and respected in the community, and knew enough to get program funding,"she says.
Their initiative paid off; today, the CNA Career Alliance receives grant support from the United Way, a City of Madison block grant, and two private foundations, says Giovannoni. It is now seeking long-term funding for other activities such as additional training for program graduates. Home care sponsoring organizations do not fund the program, but they provide valuable training and hire program graduates.
The program costs about $85,000 annually, including the director and instructor’s salaries and student support, explains Kay McGee, program director. Start-up expenses, including staff time to develop curriculum, policies, and procedures and applications, were about $50,000, she estimates.
This does not include time spent by executives of affiliated home health and community-based organizations, Giovannoni adds. Career Alliance organizers did not consider funding the program themselves. Like Independent Living, many could not continue their existing recruitment activities and also support the Alliance, she explains.
While acknowledging the unique collaboration among competitors, Giovannoni says, "Ultimately, we all have the same problem of recruiting a good work force, and when the other methods aren’t working, [this is] a way to do [it] differently and create a more focused response to this problem. Hopefully, our ship [will] rise collectively."
Problem solving is a key training component
Since its inception last year, 25 people have completed CNA Career Alliance training, out of 34 people accepted in the program, says McGee. Up to seven students enroll in each eight-week session. The program’s 200 hours of training cover clinical, workplace, and life skills topics. It also includes a 40-hour practicum in which students accompany CNAs employed by sponsoring home health organizations as they perform their jobs.
In addition to clinical subjects such as infection control, nutrition, bathing, and transferring, students learn equally important lessons about problem solving and conflict resolution — both on the job and in their personal lives, she says.
For example, participants discuss how to deal with the prejudice among the elderly who will largely make up their case loads. Many commonly refer to their African American caregivers as "colored girls," McGee explains.
Students’ complicated lives also create various workplace dilemmas, so they discuss responses to punctuality and attendance challenges such as missing the bus, having a sick child, or quarreling most of the night with one’s partner.
The Alliance recruits students from the Dane County (Madison, WI) Job Center, Dane County Head Start program, and other community-based organizations. It also advertises in a local minority newspaper and the Urban League of Greater Madison’s newsletter.
McGee extensively screens applicants with personal interviews and criminal background and driver’s checks. Those accepted must also have high school diplomas or GEDs. These requirements eliminate about 60% of applicants, according to McGee.
Caregiving experience — formal or informal — is also valued. "We will accept people without formal work experience who’ve cared for someone," says McGee. Applicants also take the CurryScreen Nursing Assistant and Home Health Aide screening test. (See Private Duty Homecare, December 1997, p. 138, and August 1997, p. 90, for more on the CurryScreen.) Although the screen predicts job performance, attendance, and longevity, McGee does not use it as a program entrance hurdle. "I use it as a test of honesty and integrity [and] as a tool to [see whether they can] follow instructions," she explains.
The average student is a 30-year-old single mother, according to McGee. About 40% of program graduates are African American; 32% are Caucasian, with the remainder mostly Hispanic. Nearly two-thirds are public assistance recipients; the remainder are working poor individuals with no aid.
The Alliance’s grant funding pays students a $4 per hour stipend during training. It also covers their $500 tuition and book expense, child care, and transportation needs during the eight-week program. The Alliance also has six cars that graduates may use in their first home health jobs. Child care support continues until graduates qualify for state-funded assistance. It costs from $1,000 to $3,000 per trainee, depending on the individual’s need, McGee estimates.
Trainees must sign a contract that requires them to reimburse half of their training costs if they stop working within six months after graduating. "I realize you can’t collect money from people who don’t have it. [I ask for this] for its psychological value as a commitment. I tell the students, Stay with me. I know your life is complicated, but it will get better,’" she says.
Sticking with the program is one of the main lessons McGee tries to impart. Difficult life circumstances make it easier for program graduates to bolt rather than resolve conflicts. "[I educate students that] they can stay and work out problems. They have this all or nothing’ mentality, and if they have one disagreement [with an employer], they say I’m outta here!’ But I try to tell them, This is your career,’" she explains.
While the CNA Career Alliance is successful — it has hired six CNAs that Independent Living would not have located through its normal recruitment efforts — program graduates require special attention and resources, says Giovannoni. Many have ongoing difficulties juggling their personal and work lives that other employees are experienced at handling, such as making it to work even though they missed the bus or their child has a doctor’s appointment. Not uncommonly, sometimes program graduates deal with such issues by not showing up for work and not phoning in to report a problem. This requires much intervention from both McGee and the home health providers. "Most employers don’t have time for it, but you have to help with skill building and problem solving to make them successful," Giovannoni explains.
To improve the retention and job performance of both CNA Career Alliance graduates and other CNAs, Independent Living recently created two CNA mentor positions, says Giovannoni. The mentors, taken from the ranks of Independent Living’s experienced CNAs, help fellow CNAs with day-to-day problem solving. They closely monitor peers with co-visits and phone calls. "It really helps to have someone to talk to and for the organization to take the initiative [to reach out] rather than relying on staff to call in with questions," she says.
Steady work schedules also influence program graduates’ longevity, says McGee. Although there is a huge demand for paraprofessional services in home care, providers have difficulty stringing four- and six-hour work assignments together to make a forty hour work week, she explains.
The Independent Living scheduler "works very closely with CNAs to get them at full-time activity. We know we stand a good chance of losing employees if we don’t keep them at or near 40 hours," says Giovannoni. The company also keeps benefit funding constant even with flexible hours, and it guarantees hours for certain employees, she adds.
Despite the special challenges of working with graduates, the CNA Career Alliance is a success, say McGee and Giovannoni. The combined concentrated recruitment efforts, home health curricula and practicum, ongoing mentorship, and daily living support appear to bring in people more interested in and committed to home care, they note.
"It really is a good program. It’s wonderful; it’s giving people a chance," says McGee.
• Rita Giovannoni, MS, Executive Director, Independent Living Inc., 437 S. Yellowstone Dr., Suite 208, Madison, WI 53719. Telephone: (608) 274-7900.
• Kay McGee, Director, CNA Career Alliance, 101 East Mifflin St., Madison, WI 53703. Telephone: (608) 257-1436.
Sources
• Rita Giovannoni, MS, Executive Director, Independent Living Inc., 437 S. Yellowstone Dr., Suite 208, Madison, WI 53719. Telephone: (608) 274-7900.
• Kay McGee, Director, CNA Career Alliance, 101 East Mifflin St., Madison, WI 53703. Telephone: (608) 257-1436.
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