Inside the ‘Learn and Earn’ Trend for Successful New Nursing Home Workforce Programs Across US

At the heart of successful new hiring programs backed by nursing homes across the United States is the philosophy that nurses deserve better pay, free training, a guaranteed job, and an easier path to career advancement.

State-level initiatives from Hawaii to the Midwest are gaining traction by allowing workers to train for specialized positions while pursuing their existing jobs. These programs also not only guarantee employment, but give operators and clinical staff a chance to recoup costs and tie bonuses for completing committed time.

Operators across many states are finding success in using these programs to train and promote non-clinical workers, such as in hospitality and housekeeping, to become certified nursing assistants (CNAs), while others are availing the opportunities to allow clinical staff to deepen their skills and become licensed practical nurses (LPNs) or even registered nurses (RNs).

And states are tapping government funding to support the initiatives.

“The additional Medicaid dollars that we’ve received in Wisconsin have been helpful in at least allowing our facilities to be competitive with our hospitals and with other industries in retaining and attracting our employees,” said Rick Abrams, CEO and President of the Wisconsin Health Care Association/Wisconsin Center for Assisted Living.

Working while training — with guaranteed employment at the training’s completion — is what makes Wisconsin’s program click, Abrams said.

“The facility hires the candidate, and then they run them through the training so that the candidate is getting paid, or maybe they’re doing another job in the facility as they train,” said Abrams. “So it’s not one of these things where you take someone off the street, you train them, and maybe they stay on to work as a CNA [or not].”

This path to guaranteed employment avoids the problem of training non-committed workers because the facilities have already sifted through the candidates, whether by hiring from within or a more rigorous interview process, Abrams explained.

This is especially important in rural states like Wisconsin, where nursing homes have been unable to staff their beds due to a severe staffing shortage, leading to closures and bed reductions. In Wisconsin alone, about 2,700 nursing home beds have been lost since the start of the pandemic.

The state’s WisCaregiver Careers program, administered by the nursing home trade associations and funded by money from the American Rescue Plan Act (ARPA), is all about expanding the pool of certified nursing assistants (CNAs), Abrams explained.

Individuals can get free training, free certification testing, and receive a $500 sign-on or retention bonus. The program’s goal is to attract new workers by lowering the costs of becoming a CNA and by making training more readily accessible. Even in a short period of time since its inception, it’s clearly working, Abrams said.

“It’s programs like that, which will begin to build the bench,” Abrams said.

‘The glide path’ enriches pipeline

The success of such programs is evident in the models springing forth across the nation, with Indiana, Minnesota, Arizona, North Carolina and Hawaii all providing similar incentives.

In Hawaii, they call this approach “learn and earn.” Providers like Ohana Pacific Health, the state’s largest post-acute care organization, are at the forefront of using this approach in Hawaii to great success, according to the organization’s CEO Wesley Lo.

Ohana has 11 health care entities that employ approximately 1,500 employees across long-term care, rehabilitation services, memory care, home health services and adult day health programs.

Ohana Pacific is currently putting many of its CNAs through Hawaii’s workforce initiatives that guarantee employment and funds for CNAs to become trained as LPNs.

The organization has four running cohorts, with room for up to 10 CNAs in each, that allow nursing aides to work across several of Ohana Pacific’s facilities, including a skilled nursing facility (SNF). These cohorts are all almost full, Lo said, pointing to the program’s success.

The program also offers a way for operators to strengthen their pipeline for clinical workers.

“We’re seeing more people apply for CNAs now than we ever saw before because they want to get into that program,” he said. “Now, one day those LPNs might leave, but we’re hoping we’ll continually have this backfill of people coming in because they are given an opportunity that they probably never would have had before.”

The condition of the learn-and-earn program is that all of the CNAs have to be working, and that each organization allows them to get an education for nursing at a community college and train with the employer.

All of the CNAs in this program who are working currently for Ohana Pacific will complete their clinical training at Ohana’s facilities and within a year they are able to become an LPN, Lo said.

“We hire CNAs that get into this program, and they work for us part time, for at least 20 hours a week, and their other time is basically spent getting an education at the community college … We actually do the training at our facilities, and we actually jointly hire the clinical educator in our facility to supplement the academic part,” Lo said.

Now one may argue, Lo says, that getting CNAs to accomplish specialized training might be a losing proposition for the operator because after becoming an LPN, the trainees might leave for a higher paid job in a hospital setting. However, he has discovered that the motivation and prospect of higher wages is a big incentive to enrich the pipeline of nurses in Hawaii.

“What we’re finding is that if I just try to hire CNAs to be CNAs forever, we continually lose them because they’re going to take the job that’s going to give them 50 cents more per hour,” he said. “So our theory is that we need to develop a glide path that gets people to a higher level that makes them a living wage.”

Tuition-free job training with higher wages helps retention

Meanwhile, in Indiana, things are also proceeding with an urgency to resolve the labor crisis, and training and workforce funding programs for high demand jobs have been a steady source of support.

The workforce initiative known as “Next Level Jobs” enables tuition-free job training funded through government grants for licensed and vocational nurses as well as nurse’s aides. And, employers receive reimbursements for up to $5,000 to train each CNA, provided the operators retain the employees for at least six months.

Although this workforce program has been around since 2017, it has only recently been bolstered with more funding to allow for wage increases, and the efforts are bearing fruit.

“I think for folks in the industry, they also recognize the turnover of CNAs is high, even when there’s that commitment from the practitioner to be in that job. And the retention numbers are up for that position,” said Nick Goodwin, director of government affairs at the Indiana Health Care Association/Indiana Center for Assisted Living (IHCA/INCAL).

“They, most recently in the past year, added a wage increase component. So not only do they have to retain with us for six months, they recoup the training, but we also have to offer them a 3% bump [in wages],” said Goodwin.

Beyond the wage increase, recruitment efforts at the high school level have helped outreach, with policy makers banking on introducing the training early to future nurses with hopes to ultimately push retention numbers up.

“We have made a huge concerted effort to get involved in the high school space through career and technical education programs,” said Goodwin.

He believes that individuals who already have experienced the long-term care setting, from a clinical standpoint, are more likely to show “progressions and persistence” in the field, compared to workers who are new to long-term care, join a CNA program, and then discover they are not well suited to the job.

Currently, Indiana’s shortage is about on par with the national average for health care workers, and down about 15% from 2020, for a shortage of 7,000 to 8,000 workers, Goodwin said. The shortage was as high as 10,000 to 11,000 at the peak during the pandemic.

“We’ve started to see a slow recovery,” he said. “But as we looked at physician offices, hospitals and everybody else, home health agencies, you name it, they’re pretty much restored to their pre-pandemic levels while we in long-term care, we haven’t recovered yet.”

Rural states have to reimagine workforce initiatives

And more rural, sparsely populated states like Minnesota are having to grapple with their own set of issues, including long distances of travel and fewer people entering the clinical care profession.

Moreover, operators in such states are expected to be extra resourceful and some have even encouraged their non-clinical staff such as dietary aides and housekeepers to get trained for clinical work.

But beyond that, the unique challenges stemming from the rural setting means that existing workforce initiatives have to be reimagined.

And so, the nursing home sector seeks to improve an existing workforce program by guaranteeing employment, according to Nicole Mattson, vice president of strategic initiatives at Care Providers of Minnesota, the state affiliate of AHCA/NCAL.

The current workforce program, called the Next Generation Nursing Assistant, is supported by Minnesota’s Office of Higher Education with ARPA and pandemic-era funds, and has had limited results, said Mattson.

“In the first go round, they trained close to 2,000. And this last time they trained close to 1,000. So altogether, we’ve got about 3,000 people that have gone through the program … And many of our providers did participate in it,” she said.

However, a survey of 600 participants who went through the training revealed that only about half of them retained their jobs as nurses, Mattson said.

“The intention was to attract new people to the profession, to eliminate any potential barriers that somebody might have, and be highly supportive so that they could get the training and testing done, and then enter the long-term care workforce,” said Mattson, but she added, “The success rate isn’t exactly where we want it to be.”

Now, the stress is on improving recruitment and retention by guaranteeing employment, Mattson said:

“We would want to see stronger connections to employment, which is why we talked with the state of Wisconsin, because their model has the [condition] that the individual gains employment first. And then, that participating employer signs them up for free training. So we were intrigued by that model, and I see a lot of value in having a connection with an employer.”